Provider Demographics
NPI:1104573039
Name:GRANT, ELAINE MARIE (RPH)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARIE
Last Name:GRANT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:786 D STREET
Mailing Address - Street 2:
Mailing Address - City:JBER
Mailing Address - State:AK
Mailing Address - Zip Code:99505
Mailing Address - Country:US
Mailing Address - Phone:907-384-0610
Mailing Address - Fax:
Practice Address - Street 1:786 D STREET
Practice Address - Street 2:
Practice Address - City:JBER
Practice Address - State:AK
Practice Address - Zip Code:99505-9965
Practice Address - Country:US
Practice Address - Phone:907-384-0610
Practice Address - Fax:907-384-8195
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPHAP1269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist