Provider Demographics
NPI:1154926798
Name:GRANADOS, ISAI (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ISAI
Middle Name:
Last Name:GRANADOS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 W EDINBURG AVE
Mailing Address - Street 2:
Mailing Address - City:ELSA
Mailing Address - State:TX
Mailing Address - Zip Code:78543-3006
Mailing Address - Country:US
Mailing Address - Phone:956-262-6292
Mailing Address - Fax:956-262-6784
Practice Address - Street 1:103 W EDINBURG AVE
Practice Address - Street 2:
Practice Address - City:ELSA
Practice Address - State:TX
Practice Address - Zip Code:78543-3006
Practice Address - Country:US
Practice Address - Phone:956-262-6292
Practice Address - Fax:956-262-6784
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist