Provider Demographics
NPI:1790899771
Name:GRANT PHARMACIST GROUP INC
Entity Type:Organization
Organization Name:GRANT PHARMACIST GROUP INC
Other - Org Name:TOTAL CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:FRONK
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:606-845-3421
Mailing Address - Street 1:40 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:DRY RIDGE
Mailing Address - State:KY
Mailing Address - Zip Code:41035-9762
Mailing Address - Country:US
Mailing Address - Phone:859-823-0200
Mailing Address - Fax:859-823-4500
Practice Address - Street 1:40 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:DRY RIDGE
Practice Address - State:KY
Practice Address - Zip Code:41035-9762
Practice Address - Country:US
Practice Address - Phone:859-823-0200
Practice Address - Fax:859-823-4500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X, 3336M0003X, 3336S0011X
KYP072723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2034093OtherPK
KY7100055140Medicaid
2034093OtherPK