Provider Demographics
NPI:1467883298
Name:GRANTHAM, AMBER DEANNE (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:DEANNE
Last Name:GRANTHAM
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 SEBASTIAN DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1632
Mailing Address - Country:US
Mailing Address - Phone:731-343-9559
Mailing Address - Fax:
Practice Address - Street 1:93 STONEBROOK PL
Practice Address - Street 2:TARGET PHARMACY
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3637
Practice Address - Country:US
Practice Address - Phone:731-660-2845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN94761835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy