Provider Demographics
NPI:1982990180
Name:GRANAHAN, BONNIE RHODES (RPH)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:RHODES
Last Name:GRANAHAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 INDUSTRIAL BLVD
Mailing Address - Street 2:T-2360
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6865
Mailing Address - Country:US
Mailing Address - Phone:615-768-3018
Mailing Address - Fax:615-768-3028
Practice Address - Street 1:803 INDUSTRIAL BLVD
Practice Address - Street 2:T-2360
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6865
Practice Address - Country:US
Practice Address - Phone:615-768-3018
Practice Address - Fax:615-768-3028
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-26
Last Update Date:2011-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist