Provider Demographics
NPI:1558967703
Name:GRANT, MEGAN M
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:M
Last Name:GRANT
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 1:3488 SELDOM SEEN RD
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-8405
Mailing Address - Country:US
Mailing Address - Phone:614-718-1508
Mailing Address - Fax:
Practice Address - Street 1:3488 SELDOM SEEN RD
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-8405
Practice Address - Country:US
Practice Address - Phone:614-718-1508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3671965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist