Provider Demographics
NPI:1346520186
Name:GRAUSS, NENENG BRETAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:NENENG
Middle Name:BRETAN
Last Name:GRAUSS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 VINTAGE WAY
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-5007
Mailing Address - Country:US
Mailing Address - Phone:415-899-1337
Mailing Address - Fax:415-899-8544
Practice Address - Street 1:300 VINTAGE WAY
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5007
Practice Address - Country:US
Practice Address - Phone:415-899-1337
Practice Address - Fax:415-899-8544
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist