Provider Demographics
NPI:1790061596
Name:GRAUMENZ, MITCH (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MITCH
Middle Name:
Last Name:GRAUMENZ
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 MILLWELL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-2512
Mailing Address - Country:US
Mailing Address - Phone:314-727-8787
Mailing Address - Fax:
Practice Address - Street 1:212 MILLWELL DR
Practice Address - Street 2:SUITE A
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-2512
Practice Address - Country:US
Practice Address - Phone:314-727-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011021856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist