Provider Demographics
NPI:1598104358
Name:GRANITE STATE PHARMACY LLC
Entity Type:Organization
Organization Name:GRANITE STATE PHARMACY LLC
Other - Org Name:GRANITE STATE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:BEANE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:603-393-8096
Mailing Address - Street 1:5 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2303
Mailing Address - Country:US
Mailing Address - Phone:603-224-7429
Mailing Address - Fax:603-224-7042
Practice Address - Street 1:5 CLINTON ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2303
Practice Address - Country:US
Practice Address - Phone:603-224-7429
Practice Address - Fax:603-224-7042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy