Provider Demographics
NPI:1376556159
Name:GRANT, GARY H (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:H
Last Name:GRANT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3127 E HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-5415
Mailing Address - Country:US
Mailing Address - Phone:850-769-3177
Mailing Address - Fax:850-769-3813
Practice Address - Street 1:3127 E HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-5415
Practice Address - Country:US
Practice Address - Phone:850-769-3177
Practice Address - Fax:850-769-3813
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS19425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist