Provider Demographics
NPI:1679997514
Name:GRANT, VANCE EDWARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:VANCE
Middle Name:EDWARD
Last Name:GRANT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 POOCHAM RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTERFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03466-3411
Mailing Address - Country:US
Mailing Address - Phone:603-256-8586
Mailing Address - Fax:
Practice Address - Street 1:354 WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3936
Practice Address - Country:US
Practice Address - Phone:603-352-6969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-12
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.100439183500000X
CTPCT.0008807183500000X
NHR1983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist