Provider Demographics
NPI:1750670519
Name:GRANTZ, EARL GENE
Entity Type:Individual
Prefix:MR
First Name:EARL
Middle Name:GENE
Last Name:GRANTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:EARL
Other - Middle Name:GENE
Other - Last Name:GRANTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:707 E IVY DRIVE
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973
Mailing Address - Country:US
Mailing Address - Phone:302-628-8478
Mailing Address - Fax:
Practice Address - Street 1:1251 BRITTINGHAM LANE
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853
Practice Address - Country:US
Practice Address - Phone:410-651-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist