Provider Demographics
NPI:1891176129
Name:GRANADOS, HOLLI RENEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:HOLLI
Middle Name:RENEE
Last Name:GRANADOS
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 1:30530 RANCHO CALIFORNIA RD
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-3277
Mailing Address - Country:US
Mailing Address - Phone:951-694-0055
Mailing Address - Fax:951-694-5645
Practice Address - Street 1:30530 RANCHO CALIFORNIA RD
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-3277
Practice Address - Country:US
Practice Address - Phone:951-694-0055
Practice Address - Fax:951-694-5645
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist