Healthcare Provider Details

I. General information

NPI: 1033200373
Provider Name (Legal Business Name): EDWARD SCOTT GRANGER D. PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N MAIN ST
SWEETWATER TN
37874-2806
US

IV. Provider business mailing address

1416 AMBLEWINDS CIR
KNOXVILLE TN
37922-1465
US

V. Phone/Fax

Practice location:
  • Phone: 423-337-5813
  • Fax:
Mailing address:
  • Phone: 865-691-3612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberC-5857
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: