Provider Demographics
NPI:1548791270
Name:GRANGER PHARMACY
Entity Type:Organization
Organization Name:GRANGER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TECH
Authorized Official - Prefix:
Authorized Official - First Name:SANDALEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-245-6422
Mailing Address - Street 1:2965 W 3500 S
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-3602
Mailing Address - Country:US
Mailing Address - Phone:801-965-3639
Mailing Address - Fax:
Practice Address - Street 1:3725 W 4100 S
Practice Address - Street 2:
Practice Address - City:WEST VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84120-5530
Practice Address - Country:US
Practice Address - Phone:801-965-3639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-24
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6729928-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty