Provider Demographics
NPI:1023274651
Name:GRANT PHARMACISTS GROUP INC
Entity type:Organization
Organization Name:GRANT PHARMACISTS GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-823-0200
Mailing Address - Street 1:209 S MAIN CROSS ST
Mailing Address - Street 2:
Mailing Address - City:FLEMINGSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41041-1203
Mailing Address - Country:US
Mailing Address - Phone:606-845-2101
Mailing Address - Fax:606-849-2633
Practice Address - Street 1:40 BROADWAY
Practice Address - Street 2:
Practice Address - City:DRY RIDGE
Practice Address - State:KY
Practice Address - Zip Code:41035
Practice Address - Country:US
Practice Address - Phone:859-823-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1828055OtherNCPDP
KY7100055140Medicaid
KY4277860002Medicare NSC