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General NPI Number Information
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NPI Number | 1649285263
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Entity Type | Organization
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Legal Business Name | GRANDIN PHARMACY LLC
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 09/21/2007
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Provider Practice Location Address
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Address Line | 1327 GRANDIN RD SW
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City | ROANOKE
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State | VA
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Zip | 24015-2315
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Country | US
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Telephone | 540-777-3403
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Fax | 540-777-3406
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Provider Business Mailing Address
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Address Line | 1327 GRANDIN RD SW
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City | ROANOKE
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State | VA
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Zip | 24015-2315
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Country | US
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Telephone | 540-777-3403
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Fax | 540-777-3406
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Authorized Official
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Title or Position | OWNER
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Name | MR. CHARLES WEST
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Credential | RPH
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Telephone | 540-774-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 0201004016
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License Number State | VA
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