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General NPI Number Information
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NPI Number | 1013968023
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Entity Type | Organization
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Legal Business Name | GRANVILLE MEDICAL PHARMACY INC.
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6212 N BROADWAY ST
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City | CHICAGO
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State | IL
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Zip | 60660-1903
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Country | US
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Telephone | 773-274-5888
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Fax | 773-274-5961
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Provider Business Mailing Address
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Address Line | 6212 N BROADWAY ST
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City | CHICAGO
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State | IL
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Zip | 60660-1903
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Country | US
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Telephone | 773-274-5888
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Fax | 773-274-5961
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Authorized Official
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Title or Position | PRESIDENT/PHARMACIST
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Name | MR. ROBERT S. JOSEPH
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Credential | RPH.
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Telephone | 847-729-9034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State | IL
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