Provider Demographics
NPI:1285042234
Name:GRANT, PETER (PHARMD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:GRANT
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 1:1815 WYLIE ST
Mailing Address - Street 2:UNIT D
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2100
Mailing Address - Country:US
Mailing Address - Phone:484-680-5668
Mailing Address - Fax:
Practice Address - Street 1:1503 LANSDOWNE AVE
Practice Address - Street 2:SUITE 1000
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1330
Practice Address - Country:US
Practice Address - Phone:610-237-7330
Practice Address - Fax:610-237-7333
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2016-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA10004375183500000X
PARP447537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist