MEDICARE: GRANT PHARMA INC

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
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	032731	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2146630	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710303821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANT PHARMA INC

Provider Business Mailing Address
First Line	:	1340 EDWARD L GRANT HIGHWAY
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452
Country	:	US
Telephone Number	:	718-588-3304
Fax Number	:	718-588-2318

Provider Business Practice Location Address
First Line	:	1340 EDWARD L GRANT HWY
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452-3144
Country	:	US
Telephone Number	:	718-588-3304
Fax Number	:	718-588-2318

Authorized Official
Title or Position	:	PHARMACY MANAGER / PHARMACIST
Name	:	MR. SRINIVASA REDDY YANNAM
Credential	:
Telephone Number	:	718-588-3304

Provider Enumeration Date	:	03/13/2014
Last Update Date	:	10/06/2020

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