Provider Demographics
NPI:1710630108
Name:GRANTZ, LAUREN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:GRANTZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 LEHIGH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-4904
Mailing Address - Country:US
Mailing Address - Phone:484-894-5503
Mailing Address - Fax:
Practice Address - Street 1:2024 LEHIGH ST STE 500
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-4904
Practice Address - Country:US
Practice Address - Phone:484-894-5503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP441958OtherSBOP LICENSE NUMBER