Provider Demographics
NPI:1659694594
Name:PARRAMORE, GRANTHAM D
Entity Type:Individual
Prefix:
First Name:GRANTHAM
Middle Name:D
Last Name:PARRAMORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 COUNTY ROAD 210 W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4058
Mailing Address - Country:US
Mailing Address - Phone:904-823-2171
Mailing Address - Fax:904-823-2159
Practice Address - Street 1:2220 COUNTY ROAD 210 W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-4058
Practice Address - Country:US
Practice Address - Phone:904-823-2171
Practice Address - Fax:904-823-2159
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-07
Last Update Date:2010-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS166211835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist