Provider Demographics
NPI:1831579440
Name:NOLAN, GRANT DANIEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:DANIEL
Last Name:NOLAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-6514
Mailing Address - Country:US
Mailing Address - Phone:804-262-2390
Mailing Address - Fax:
Practice Address - Street 1:10100 BROOK RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-6514
Practice Address - Country:US
Practice Address - Phone:804-262-2390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202213840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist