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NPI Code Detail

MEDICARE: MR. DOUGLAS GRANER RPH

MEDICARE: MR. DOUGLAS GRANER RPH
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
1183500000XPharmacist031672-1NY

General Provider Information

NPI Number : 1164745592
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DOUGLAS GRANER RPH
Provider Business Mailing Address
First Line : 8345 LANGDALE ST
Second Line :
City : NEW HYDE PARK
State : NY
Zip : 11040-1822
Country : US
Telephone Number : 718-470-0208
Fax Number :
Provider Business Practice Location Address
First Line : 8345 LANGDALE ST
Second Line :
City : NEW HYDE PARK
State : NY
Zip : 11040-1822
Country : US
Telephone Number : 718-470-0208
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2010
Last Update Date : 03/12/2010

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