Provider Demographics
NPI:1194073965
Name:GRAUSS, PHILLIP EDWIN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:EDWIN
Last Name:GRAUSS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:350 MARIN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-5438
Mailing Address - Country:US
Mailing Address - Phone:415-246-9050
Mailing Address - Fax:415-883-9057
Practice Address - Street 1:5901 REDWOOD DR
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2076
Practice Address - Country:US
Practice Address - Phone:707-540-9112
Practice Address - Fax:707-540-9133
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA243451835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist