Provider Demographics
NPI:1588661201
Name:GRANCEY, SUSAN L (RPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:GRANCEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-2527
Mailing Address - Country:US
Mailing Address - Phone:814-765-5371
Mailing Address - Fax:814-762-8755
Practice Address - Street 1:304 N 3RD ST
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-2527
Practice Address - Country:US
Practice Address - Phone:814-765-5371
Practice Address - Fax:814-762-8755
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP036635L183500000X
VA0202 010287183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00153318 0001Medicaid
PA5044670001Medicare ID - Type Unspecified