Provider Demographics
NPI:1811138159
Name:GRANNICK, DEBRA R (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:R
Last Name:GRANNICK
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 1:4605 MORENA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-3650
Mailing Address - Country:US
Mailing Address - Phone:858-581-4550
Mailing Address - Fax:858-581-4424
Practice Address - Street 1:4605 MORENA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-3650
Practice Address - Country:US
Practice Address - Phone:858-581-4550
Practice Address - Fax:858-581-4424
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42880183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist