Provider Demographics
NPI:1215269261
Name:GRAD, LUCY ANNE (RPH)
Entity type:Individual
Prefix:MRS
First Name:LUCY
Middle Name:ANNE
Last Name:GRAD
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 1:8187 GREINER RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2814
Mailing Address - Country:US
Mailing Address - Phone:716-633-8185
Mailing Address - Fax:
Practice Address - Street 1:4777 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-4772
Practice Address - Country:US
Practice Address - Phone:716-515-3290
Practice Address - Fax:716-515-3294
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS33838183500000X
NY046572183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist