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General NPI Number Information
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NPI Number | 1922154756
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Entity Type | Organization
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Legal Business Name | GRANGER PHARMACY
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 2965 W 3500 S
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City | WEST VALLEY CITY
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State | UT
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Zip | 84119-3602
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Country | US
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Telephone | 801-965-3639
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Fax | 801-965-9641
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Provider Business Mailing Address
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Address Line | 2965 W 3500 S # W3500S
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City | WEST VALLEY CITY
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State | UT
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Zip | 84119-3602
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Country | US
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Telephone | 801-965-3639
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Fax | 801-965-9641
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRYAN ALLRED
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Credential | PHARM. D.
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Telephone | 801-597-5650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 10310634-1703
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 10310634-1703
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License Number State | UT
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