Provider Demographics
NPI:1184792871
Name:GRANNICK PHARMACY, INC.
Entity type:Organization
Organization Name:GRANNICK PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRANNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-869-3492
Mailing Address - Street 1:277 GREENWICH AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6503
Mailing Address - Country:US
Mailing Address - Phone:203-869-3492
Mailing Address - Fax:203-625-5590
Practice Address - Street 1:277 GREENWICH AVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6503
Practice Address - Country:US
Practice Address - Phone:203-869-3492
Practice Address - Fax:203-625-5590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT728333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy