Provider Demographics
NPI:1952689630
Name:GRANT, SYMPHONIE CHARLES (PHARMD)
Entity Type:Individual
Prefix:
First Name:SYMPHONIE
Middle Name:CHARLES
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 1:5175 BROOKBERRY PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-3784
Mailing Address - Country:US
Mailing Address - Phone:336-245-3009
Mailing Address - Fax:336-245-3008
Practice Address - Street 1:5175 BROOKBERRY PARK AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-3784
Practice Address - Country:US
Practice Address - Phone:336-245-3009
Practice Address - Fax:336-245-3008
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207893183500000X
NC22288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist