Provider Demographics
NPI:1437549227
Name:GRANADOS, JENIMAE
Entity Type:Individual
Prefix:
First Name:JENIMAE
Middle Name:
Last Name:GRANADOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 MONROE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-2674
Mailing Address - Country:US
Mailing Address - Phone:240-643-9756
Mailing Address - Fax:
Practice Address - Street 1:5700 BOU AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1663
Practice Address - Country:US
Practice Address - Phone:301-945-0019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-31
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician