# GRANITE PHARMACY INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** GRANITE PHARMACY INC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205878501
- **Authorized official:** LISA DOCKHAM RPH. (PRESIDENT)
- **Authorized official phone:** (802) 527-9930

## Contact information

- **Practice address:** 576 BALLARD RD STE 2, MILTON, VT 05468-4210
- **Practice address phone:** (802) 527-9930
- **Practice address fax:** (802) 527-9764
- **Mailing address:** 576 BALLARD RD STE 2, PO BOX 2094, MILTON, VT 05468-4210
- **Mailing address phone:** (802) 527-9930
- **Mailing address fax:** (802) 527-9764

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 141-0003297 | VT | Yes |

## Other

- **Enumeration date:** 06/12/2006
- **Last updated:** 10/26/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1006503 | — | VT |
| 01 | — | 2101633 | PK | — |