Provider Demographics
NPI:1316541055
Name:GRANDON, KAL (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAL
Middle Name:
Last Name:GRANDON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 S LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30830-4543
Mailing Address - Country:US
Mailing Address - Phone:706-554-2186
Mailing Address - Fax:
Practice Address - Street 1:317 S LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:GA
Practice Address - Zip Code:30830-4543
Practice Address - Country:US
Practice Address - Phone:706-554-2186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030331183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist