Provider Demographics
NPI:1205080975
Name:GRENADA PHARMNET
Entity type:Organization
Organization Name:GRENADA PHARMNET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAINELLI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-294-1111
Mailing Address - Street 1:403 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MS
Mailing Address - Zip Code:38967-2113
Mailing Address - Country:US
Mailing Address - Phone:662-283-1331
Mailing Address - Fax:
Practice Address - Street 1:353 W MONROE ST
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-5227
Practice Address - Country:US
Practice Address - Phone:662-294-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHARMNET
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07944/02.0333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy