Provider Demographics
NPI:1033763305
Name:GRAVNING, ALAN (RPH)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:GRAVNING
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1059
Mailing Address - Street 2:
Mailing Address - City:THOMPSON FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59873-1059
Mailing Address - Country:US
Mailing Address - Phone:406-827-4349
Mailing Address - Fax:406-827-9640
Practice Address - Street 1:1221 MAIN ST
Practice Address - Street 2:
Practice Address - City:THOMPSON FALLS
Practice Address - State:MT
Practice Address - Zip Code:59873-9355
Practice Address - Country:US
Practice Address - Phone:406-827-4349
Practice Address - Fax:406-827-9640
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5183183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist