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General NPI Number Information
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NPI Number | 1710303821
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Entity Type | Organization
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Legal Business Name | GRANT PHARMA INC
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Dates
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Enumeration Date | 03/13/2014
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 1340 EDWARD L GRANT HWY
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City | BRONX
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State | NY
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Zip | 10452-3144
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Country | US
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Telephone | 718-588-3304
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Fax | 718-588-2318
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Provider Business Mailing Address
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Address Line | 1340 EDWARD L GRANT HIGHWAY
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City | BRONX
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State | NY
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Zip | 10452
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Country | US
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Telephone | 718-588-3304
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Fax | 718-588-2318
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Authorized Official
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Title or Position | PHARMACY MANAGER / PHARMACIST
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Name | MR. SRINIVASA REDDY YANNAM
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Credential |
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Telephone | 718-588-3304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 032731
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License Number State | NY
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