Provider Demographics
NPI:1760514236
Name:GRAU, ANGELA S (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:S
Last Name:GRAU
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 1:7395 UTICA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-1705
Mailing Address - Country:US
Mailing Address - Phone:315-376-7551
Mailing Address - Fax:315-376-4353
Practice Address - Street 1:7395 UTICA BLVD
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1705
Practice Address - Country:US
Practice Address - Phone:315-376-7551
Practice Address - Fax:315-376-4353
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI046777183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist