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General NPI Number Information
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NPI Number | 1295058410
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Entity Type | Individual
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Provider Name | JENNIFER GRANT RPH
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Gender | Female
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Dates
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Enumeration Date | 03/02/2010
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Last Update Date | 03/02/2010
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Provider Practice Location Address
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Address Line | 29 EAST MAIN STREET
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City | GOUVERNEUR
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State | NY
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Zip | 13642
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Country | US
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Telephone | 315-287-5002
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Fax | 180-089-8423
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Provider Business Mailing Address
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Address Line | 147 CHURCH STREET
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City | HERMON
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State | NY
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Zip | 13652
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Country | US
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Telephone |
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Fax |
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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 | 1835G0303X
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Taxonomy Name | Geriatric Pharmacist
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License Number | 20 046773
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License Number State | NY
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