=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245113372
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRANITE BAY PHARMACY ADVISORS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2025
-----------------------------------------------------
Last Update Date | 07/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8325 COVENTRY CT
-----------------------------------------------------
City | GRANITE BAY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95746-6109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-532-8946
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8325 COVENTRY CT
-----------------------------------------------------
City | GRANITE BAY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95746-6109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-532-8946
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ELIZABETH ROUS
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 916-740-6366
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P1200X
-----------------------------------------------------
Taxonomy Name | Pharmacotherapy Pharmacist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------