Individual
DR. EMILIO GRANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
3785 SIXES RD, CANTON, GA 30114-7809
(770) 720-3466
Mailing address
138 MISTY VALLEY DR, CANTON, GA 30114-7732
(617) 459-6449
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
029002
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060005303
DRIVER'S LICENSE
GA
Enumeration date
12/03/2020
Last updated
12/03/2020
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