Provider Demographics
NPI:1093967192
Name:GRANEY, JESSIE LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:LYNN
Last Name:GRANEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 S LOUISE AVE STE 1100
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-6030
Mailing Address - Country:US
Mailing Address - Phone:605-504-1351
Mailing Address - Fax:605-504-1352
Practice Address - Street 1:6100 S LOUISE AVE STE 1100
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-6030
Practice Address - Country:US
Practice Address - Phone:605-504-1351
Practice Address - Fax:605-504-1352
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20473183500000X
MN118228183500000X
NE12433183500000X
SD5403183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist