Provider Demographics
NPI:1164745592
Name:GRANER, DOUGLAS (RPH)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:
Last Name:GRANER
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 1:8345 LANGDALE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1822
Mailing Address - Country:US
Mailing Address - Phone:718-470-0208
Mailing Address - Fax:
Practice Address - Street 1:8345 LANGDALE ST
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1822
Practice Address - Country:US
Practice Address - Phone:718-470-0208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031672-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist