Provider Demographics
NPI:1336329622
Name:GRABOWSKI, NAN (RPH)
Entity Type:Individual
Prefix:MS
First Name:NAN
Middle Name:
Last Name:GRABOWSKI
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 1:1400 NOYES STREET
Mailing Address - Street 2:MOHAWK VALLEY PSYCHIATRIC CENTER - WRIGHT BUILDING
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-3852
Mailing Address - Country:US
Mailing Address - Phone:315-738-4072
Mailing Address - Fax:315-738-4022
Practice Address - Street 1:1400 NOYES STREET
Practice Address - Street 2:MOHAWK VALLEY PSYCHIATRIC CENTER - WRIGHT BUILDING
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-3852
Practice Address - Country:US
Practice Address - Phone:315-738-4072
Practice Address - Fax:315-738-4022
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI035159-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7277110UPDOtherSTATE ED DEPT IMMUNIZER