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General NPI Number Information
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NPI Number | 1962708594
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Entity Type | Individual
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Provider Name | DACIA GRANT RPH
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Gender | Female
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Dates
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Enumeration Date | 01/30/2011
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Last Update Date | 01/30/2011
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Provider Practice Location Address
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Address Line | 1998 BRUCKNER BLVD
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City | BRONX
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State | NY
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Zip | 10473-2500
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Country | US
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Telephone | 718-430-9513
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Fax | 718-430-1589
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Provider Business Mailing Address
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Address Line | 1998 BRUCKNER BLVD
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City | BRONX
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State | NY
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Zip | 10473-2500
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Country | US
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Telephone | 718-430-9513
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Fax | 718-430-1589
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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 | 055397-1
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License Number State | NY
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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 | PCT.0011175
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License Number State | CT
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