Provider Demographics
NPI:1689252744
Name:GRANGER GENETICS, LLC
Entity Type:Organization
Organization Name:GRANGER GENETICS, LLC
Other - Org Name:GRANGER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-521-7392
Mailing Address - Street 1:601 BIOTECH DR STE 156
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-5167
Mailing Address - Country:US
Mailing Address - Phone:804-521-7384
Mailing Address - Fax:
Practice Address - Street 1:601 BIOTECH DR STE 156
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5167
Practice Address - Country:US
Practice Address - Phone:804-521-7384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRANGER GENETICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-31
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy PharmacyGroup - Multi-Specialty
No333600000XSuppliersPharmacyGroup - Multi-Specialty
Yes3336C0004XSuppliersPharmacyCompounding PharmacyGroup - Multi-Specialty
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1689252744Medicaid