Provider Demographics
NPI:1912508615
Name:GRANATO, KIMBERLY BRADE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:BRADE
Last Name:GRANATO
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 1:11101 N ROCKWELL AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-2724
Mailing Address - Country:US
Mailing Address - Phone:405-773-3478
Mailing Address - Fax:
Practice Address - Street 1:11101 N ROCKWELL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-2724
Practice Address - Country:US
Practice Address - Phone:405-773-3478
Practice Address - Fax:405-773-3480
Is Sole Proprietor?:No
Enumeration Date:2020-11-08
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40904183500000X
FLPS46988183500000X
OK18507183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist