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General NPI Number Information
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NPI Number | 1760764377
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Entity Type | Individual
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Provider Name | MICHAEL RANCE GRANT R.PH.
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Gender | Male
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Dates
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Enumeration Date | 09/09/2011
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Last Update Date | 09/09/2011
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Provider Practice Location Address
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Address Line | 1150 E SIBLEY BLVD
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City | DOLTON
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State | IL
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Zip | 60419-2828
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Country | US
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Telephone | 708-841-7860
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Fax | 708-841-2061
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Provider Business Mailing Address
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Address Line | 1150 E SIBLEY BLVD
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City | DOLTON
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State | IL
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Zip | 60419-2828
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Country | US
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Telephone | 708-841-7860
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Fax | 708-841-2061
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051033175
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 361924025
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License Number State | IL
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