Provider Demographics
NPI:1952785891
Name:GRANSKOG, KARL JOSEPH (PHARMD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:JOSEPH
Last Name:GRANSKOG
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 1:31 HUNTERS RUN
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CT
Mailing Address - Zip Code:06370-2601
Mailing Address - Country:US
Mailing Address - Phone:860-694-8644
Mailing Address - Fax:
Practice Address - Street 1:31 HUNTERS RUN
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CT
Practice Address - Zip Code:06370-2601
Practice Address - Country:US
Practice Address - Phone:860-694-8644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0013330183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist