Healthcare Provider Details

I. General information

NPI: 1053602748
Provider Name (Legal Business Name): JANET EILEEN GRANGER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HARRISON AVE
CENTRALIA WA
98531-1853
US

IV. Provider business mailing address

428 NEWAUKUM VALLEY RD
CHEHALIS WA
98532-8864
US

V. Phone/Fax

Practice location:
  • Phone: 360-807-2014
  • Fax: 360-807-2053
Mailing address:
  • Phone: 360-740-8210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00009613
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: