Individual
JUDY MARIE GRAVENHORST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1309 N CASS ST, WABASH, IN 46992-1029
(260) 563-1612
Mailing address
PO BOX 334, ROANOKE, IN 46783-0334
(419) 344-0823
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26024890A
IN
Other
Enumeration date
01/21/2020
Last updated
01/21/2020
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