Provider Demographics
NPI:1811599061
Name:GRANT, CAROL ELIZABETH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ELIZABETH
Last Name:GRANT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5146 MARION MT GILEAD RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302
Mailing Address - Country:US
Mailing Address - Phone:740-389-4573
Mailing Address - Fax:740-389-4579
Practice Address - Street 1:5146 MARION MT GILEAD ROAD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302
Practice Address - Country:US
Practice Address - Phone:740-389-4573
Practice Address - Fax:740-389-4579
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03221340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist