Provider Demographics
NPI:1275694952
Name:GRAGE, CHERYL ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ANN
Last Name:GRAGE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:ANN
Other - Last Name:KNUDSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:9340 101ST CT
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-3045
Mailing Address - Country:US
Mailing Address - Phone:772-321-2196
Mailing Address - Fax:
Practice Address - Street 1:7746 BAY ST
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3427
Practice Address - Country:US
Practice Address - Phone:772-589-2043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist