Provider Demographics
NPI:1780027334
Name:GRANI, LYNN MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:GRANI
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 1:25555 15TH AVE N
Mailing Address - Street 2:
Mailing Address - City:HAWLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56549-9214
Mailing Address - Country:US
Mailing Address - Phone:218-483-0280
Mailing Address - Fax:
Practice Address - Street 1:1106 HOBART STREET
Practice Address - Street 2:
Practice Address - City:HAWLEY
Practice Address - State:MN
Practice Address - Zip Code:56549-0626
Practice Address - Country:US
Practice Address - Phone:218-486-4663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-14
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist