Individual
VIRGINIA GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1088 W BROADWAY ST, MONTICELLO, IN 47960-1816
(574) 583-3250
Mailing address
12520 MIRAMICHI TRL, CULVER, IN 46511-9768
(574) 952-9200
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26014894A
IN
Other
Enumeration date
11/06/2020
Last updated
11/06/2020
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