Provider Demographics
NPI:1659129344
Name:GRANT-COLEMAN, DONNA A
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:A
Last Name:GRANT-COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 HARRAL AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-3001
Mailing Address - Country:US
Mailing Address - Phone:914-488-7758
Mailing Address - Fax:
Practice Address - Street 1:112 QUARRY RD
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4848
Practice Address - Country:US
Practice Address - Phone:833-772-0003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist