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General NPI Number Information
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NPI Number | 1295190635
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Entity Type | Organization
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Legal Business Name | GRANGER GENETICS LLC
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Dates
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Enumeration Date | 12/30/2015
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Last Update Date | 09/08/2017
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Provider Practice Location Address
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Address Line | 601 BIOTECH DR SUITE 301
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-5167
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Country | US
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Telephone | 804-915-3845
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Fax |
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Provider Business Mailing Address
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Address Line | 601 BIOTECH DR SUITE 301
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-5167
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Country | US
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Telephone | 844-347-2643
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ELIZABETH RAFFERTY
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Credential |
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Telephone | 844-347-2643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 49D2106421
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License Number State | VA
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