Provider Demographics
NPI:1295190635
Name:GRANGER GENETICS LLC
Entity Type:Organization
Organization Name:GRANGER GENETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFFERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-347-2643
Mailing Address - Street 1:601 BIOTECH DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-5167
Mailing Address - Country:US
Mailing Address - Phone:844-347-2643
Mailing Address - Fax:
Practice Address - Street 1:601 BIOTECH DR
Practice Address - Street 2:SUITE 301
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5167
Practice Address - Country:US
Practice Address - Phone:804-915-3845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA49D2106421291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory