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General NPI Number Information
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NPI Number | 1194073965
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Entity Type | Individual
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Provider Name | PHILLIP EDWIN GRAUSS PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 08/27/2012
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Last Update Date | 08/27/2012
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Provider Practice Location Address
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Address Line | 5901 REDWOOD DR
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City | ROHNERT PARK
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State | CA
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Zip | 94928-2076
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Country | US
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Telephone | 707-540-9112
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Fax | 707-540-9133
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Provider Business Mailing Address
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Address Line | 350 MARIN OAKS DR
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City | NOVATO
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State | CA
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Zip | 94949-5438
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Country | US
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Telephone | 415-246-9050
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Fax | 415-883-9057
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 24345
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License Number State | CA
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