Individual
MICHAEL GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
20 YORK ST, NEW HAVEN, CT 06510-3220
(203) 688-1111
Mailing address
55 PARK ST, NEW HAVEN, CT 06511-5474
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0011965
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0011965
CMS
CT
Enumeration date
06/05/2019
Last updated
06/05/2019
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