Provider Demographics
NPI:1225152457
Name:GRAULAU, JEANNETTE (RPH)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:
Last Name:GRAULAU
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17633 WINDY PINE ST
Mailing Address - Street 2:
Mailing Address - City:MONTVERDE
Mailing Address - State:FL
Mailing Address - Zip Code:34756-3119
Mailing Address - Country:US
Mailing Address - Phone:407-469-2401
Mailing Address - Fax:
Practice Address - Street 1:1002 E HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-3239
Practice Address - Country:US
Practice Address - Phone:352-394-6828
Practice Address - Fax:352-394-1455
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26805183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist