Provider Demographics
NPI:1760379036
Name:ANDERTON, GRANT U (PHARMD)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:U
Last Name:ANDERTON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 GROVE LN
Mailing Address - Street 2:
Mailing Address - City:MOUND
Mailing Address - State:MN
Mailing Address - Zip Code:55364-8117
Mailing Address - Country:US
Mailing Address - Phone:801-725-3180
Mailing Address - Fax:
Practice Address - Street 1:2251 COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:MOUND
Practice Address - State:MN
Practice Address - Zip Code:55364-1546
Practice Address - Country:US
Practice Address - Phone:801-725-3180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124515183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist