Healthcare Provider Details

I. General information

NPI: 1962867077
Provider Name (Legal Business Name): GRANE SUPPLY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E UNION ST SUITE B
WEST CHESTER PA
19382-3908
US

IV. Provider business mailing address

105 GAMMA DR SUITE 100
PITTSBURGH PA
15238-2950
US

V. Phone/Fax

Practice location:
  • Phone: 610-918-4740
  • Fax: 412-968-5800
Mailing address:
  • Phone: 412-449-0680
  • Fax: 412-968-5800

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 Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP482615
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPP482615
License Number StatePA

VIII. Authorized Official

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