Healthcare Provider Details

I. General information

NPI: 1336277797
Provider Name (Legal Business Name): NANCY LADY GRANGER D.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W CLINCH AVE FORT SANDERS REGIONAL MEDICAL CENTER
KNOXVILLE TN
37916-2307
US

IV. Provider business mailing address

1901 W CLINCH AVE FORT SANDERS REGIONAL MEDICAL CENTER
KNOXVILLE TN
37916-2307
US

V. Phone/Fax

Practice location:
  • Phone: 865-541-1848
  • Fax: 865-541-1786
Mailing address:
  • Phone: 865-541-1848
  • Fax: 865-541-1786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6089
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: