Provider Demographics
NPI:1306433115
Name:GRANATA, NICHOLAS ROLLIN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ROLLIN
Last Name:GRANATA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3144
Mailing Address - Country:US
Mailing Address - Phone:630-653-6940
Mailing Address - Fax:
Practice Address - Street 1:1601 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3144
Practice Address - Country:US
Practice Address - Phone:630-653-6940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.302426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist