Provider Demographics
NPI:1952470320
Name:GRANT, YVONNE E (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:E
Last Name:GRANT
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 1:14421 GLORIETTA DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-4533
Mailing Address - Country:US
Mailing Address - Phone:818-625-6756
Mailing Address - Fax:
Practice Address - Street 1:14500 ROSCOE BLVD FL 4
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4194
Practice Address - Country:US
Practice Address - Phone:818-714-2066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38828183500000X, 1835P2201X, 1835X0200X
174H00000X
CA100281835G0303X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
No174H00000XOther Service ProvidersHealth Educator
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No1835X0200XPharmacy Service ProvidersPharmacistOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA21320587OtherNATIONAL CERTIFICATION BOARD FOR DIABETES EDUCATORS
CA200913353OtherTHE COMMISSION ON CERTIFICATION AMERICAN ASSOCIATION OF DIABETES EDUCATORS
CA2269OtherCOMMISSION FOR CERTIFICATION IN GERIATRIC PHARMACY
CA10028OtherCALIFORNIA BOARD OF PHARMACY ADVANCED PRACTICE PHARMACIST