Provider Demographics
NPI:1356441430
Name:GRANDIZIO, KATHRYN ROSE (RPH)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ROSE
Last Name:GRANDIZIO
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 1:439 MILL ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-1063
Mailing Address - Country:US
Mailing Address - Phone:570-284-4667
Mailing Address - Fax:570-284-4670
Practice Address - Street 1:439 MILL ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-1063
Practice Address - Country:US
Practice Address - Phone:570-284-4667
Practice Address - Fax:570-284-4670
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043885L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist