MEDICARE: GRANT ROBERT BILLE PHARMD

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	183500000X	Pharmacist	067883	NY

General Provider Information

NPI Number	:	1710821145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRANT ROBERT BILLE PHARMD

Provider Business Mailing Address
First Line	:	4965 TENTERDEN DR
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13215-2250
Country	:	US
Telephone Number	:	315-604-0017
Fax Number	:

Provider Business Practice Location Address
First Line	:	4965 TENTERDEN DR
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13215-2250
Country	:	US
Telephone Number	:	315-604-0017
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2026
Last Update Date	:	04/16/2026

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