Organization
GRANDMAS COUNTRY PHARMACY INC
Active
Other names
GRANDMAS COUNTRY PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
MARIANNE GLORIUS (PRESIDENT)
(362) 236-0407
Entity
Organization
Contact information
Practice address
11386 E HIGHWAY 316, FORT MC COY, FL 32134-8114
(352) 236-0407
(352) 236-6343
Mailing address
11386 E HIGHWAY 316, FORT MC COY, FL 32134-8114
(352) 236-0407
(352) 236-6343
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH0016731
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021480900
—
FL
01
—
2012542
PK
—
Enumeration date
11/25/2005
Last updated
09/04/2014
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