Provider Demographics
NPI:1689913766
Name:GRANT, ANNETTE MARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:MARIE
Last Name:GRANT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:ANNETTE
Other - Middle Name:MARIE
Other - Last Name:DENEAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1823 COLLEGE AVE
Mailing Address - Street 2:MERCY REGIONAL HEALTH CENTER
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502
Mailing Address - Country:US
Mailing Address - Phone:785-776-2880
Mailing Address - Fax:
Practice Address - Street 1:1823 COLLEGE AVE
Practice Address - Street 2:MERCY REGIONAL HEALTH CENTER
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502
Practice Address - Country:US
Practice Address - Phone:785-776-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-11654183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist