Provider Demographics
NPI:1659653681
Name:GRAD, JOANNA A (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:A
Last Name:GRAD
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 ANSIN BLVD
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2118
Mailing Address - Country:US
Mailing Address - Phone:954-874-4646
Mailing Address - Fax:
Practice Address - Street 1:600 ANSIN BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-2118
Practice Address - Country:US
Practice Address - Phone:954-874-4646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist