Healthcare Provider Details

I. General information

NPI: 1376520676
Provider Name (Legal Business Name): GRANE SUPPLY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 GAMMA DR SUITE 100
PITTSBURGH PA
15238-2950
US

IV. Provider business mailing address

209 SIGMA DR
PITTSBURGH PA
15238-2826
US

V. Phone/Fax

Practice location:
  • Phone: 412-449-0680
  • Fax: 412-968-5800
Mailing address:
  • Phone: 412-963-9150
  • Fax: 412-963-6676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP414945L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberA9-0001366
License Number StateDE
# 5
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number28RO00098600
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberP06944
License Number StateMD
# 7
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number33899
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberNRP.022450950-03
License Number StateOH
# 9
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1661-43
License Number StateWI
# 10
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberNRX0000927
License Number StateDC
# 11
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberNR1305
License Number StateNH
# 12
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number99-7543
License Number StateOK
# 13
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number36.0118428
License Number StateVT
# 14
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberNR-51151
License Number StateWY
# 15
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPP414945L
License Number StatePA

VIII. Authorized Official

Name: MR. HERBERT H HENNELL
Title or Position: VICE PRESIDENT OF REIMBURSEMENT
Credential:
Phone: 412-963-9150