Provider Demographics
NPI:1629362652
Name:ELLIOTT, GRANT ALLAN (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:GRANT
Middle Name:ALLAN
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4707 GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1816
Mailing Address - Country:US
Mailing Address - Phone:847-239-3834
Mailing Address - Fax:
Practice Address - Street 1:4707 GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1816
Practice Address - Country:US
Practice Address - Phone:847-239-3834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.294844183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist