Provider Demographics
NPI:1982041760
Name:GRANT, ELAINE MARIE
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARIE
Last Name:GRANT
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 1:7777 E HAMPDEN AVE
Mailing Address - Street 2:T-2820
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4806
Mailing Address - Country:US
Mailing Address - Phone:303-481-2822
Mailing Address - Fax:
Practice Address - Street 1:7777 E HAMPDEN AVE
Practice Address - Street 2:T-2820
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4806
Practice Address - Country:US
Practice Address - Phone:303-481-2822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19622183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist