Provider Demographics
NPI:1326059304
Name:GANA, GRACE (RPH, CGP)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:GANA
Suffix:
Gender:F
Credentials:RPH, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16125 JUANITA-WOOD WAY NE UNIT 2214
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-9444
Mailing Address - Country:US
Mailing Address - Phone:206-419-0482
Mailing Address - Fax:
Practice Address - Street 1:16125 JUANITA-WOOD WAY NE UNIT 2214
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-9444
Practice Address - Country:US
Practice Address - Phone:206-419-0482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00045962183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric