Provider Demographics
NPI:1417270349
Name:GRANDCHAMP, PATRICK J
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:GRANDCHAMP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-1557
Mailing Address - Country:US
Mailing Address - Phone:906-786-1090
Mailing Address - Fax:
Practice Address - Street 1:801 N LINCOLN RD
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1557
Practice Address - Country:US
Practice Address - Phone:906-786-1090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-06
Last Update Date:2010-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist