MEDICARE: GRAND HEALTH PHARMACY 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

Other Identifiers

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

General Provider Information

NPI Number	:	1962721241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAND HEALTH PHARMACY INC

Provider Business Mailing Address
First Line	:	349 GRAND ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10002-4628
Country	:	US
Telephone Number	:	212-228-0068
Fax Number	:	212-228-9668

Provider Business Practice Location Address
First Line	:	349 GRAND ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10002-4628
Country	:	US
Telephone Number	:	212-228-0068
Fax Number	:	212-228-9668

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. KAREN J LI
Credential	:	RPH
Telephone Number	:	212-228-0068

Provider Enumeration Date	:	05/25/2010
Last Update Date	:	12/19/2014

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