Provider Demographics
NPI:1386928984
Name:GRANDE, ALISON (PHARMD)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:GRANDE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 S 124TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-1801
Mailing Address - Country:US
Mailing Address - Phone:262-794-3661
Mailing Address - Fax:
Practice Address - Street 1:2320 W RYAN RD
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-4325
Practice Address - Country:US
Practice Address - Phone:414-761-1692
Practice Address - Fax:855-784-5296
Is Sole Proprietor?:No
Enumeration Date:2011-10-01
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008027635183500000X
KS1-14502183500000X
CA61415183500000X
CO16790183500000X
WI13652-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist