Provider Demographics
NPI:1952321713
Name:GRANT PHARMACIST GROUP INC
Entity Type:Organization
Organization Name:GRANT PHARMACIST GROUP INC
Other - Org Name:TOTAL CARE PHARMACY #4
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:606-845-3421
Mailing Address - Street 1:105 SPEARS LANE
Mailing Address - Street 2:
Mailing Address - City:CRITTENDEN
Mailing Address - State:KY
Mailing Address - Zip Code:41030
Mailing Address - Country:US
Mailing Address - Phone:859-428-0900
Mailing Address - Fax:850-813-1325
Practice Address - Street 1:105 SPEARS LANE
Practice Address - Street 2:
Practice Address - City:CRITTENDEN
Practice Address - State:KY
Practice Address - Zip Code:41030
Practice Address - Country:US
Practice Address - Phone:859-428-0900
Practice Address - Fax:850-813-1325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP06695332B00000X, 333600000X
KYP07274332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1827077OtherNCPDP
KY54002738Medicaid
KY7100056090Medicaid
KY7100056090Medicaid
KY6332750001Medicare NSC