Provider Demographics
NPI:1851992812
Name:GRANT, CINDY ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:ANN
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 1:4807 LATHROP RD
Mailing Address - Street 2:
Mailing Address - City:BERKEY
Mailing Address - State:OH
Mailing Address - Zip Code:43504-9710
Mailing Address - Country:US
Mailing Address - Phone:419-829-2657
Mailing Address - Fax:
Practice Address - Street 1:1300 E MALL DR
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-8467
Practice Address - Country:US
Practice Address - Phone:419-868-1398
Practice Address - Fax:419-868-1805
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03223375183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist