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NPI Code Detail

MEDICARE: MICHAEL GRANESE PHARM.D.

MEDICARE: MICHAEL GRANESE PHARM.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist015228KY

General Provider Information

NPI Number : 1073804415
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL GRANESE PHARM.D.
Provider Business Mailing Address
First Line : 612 W STOCKTON ST
Second Line :
City : EDMONTON
State : KY
Zip : 42129-9458
Country : US
Telephone Number : 270-432-2725
Fax Number :
Provider Business Practice Location Address
First Line : 612 W STOCKTON ST
Second Line :
City : EDMONTON
State : KY
Zip : 42129-9458
Country : US
Telephone Number : 270-432-2725
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2011
Last Update Date : 04/19/2011

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