Provider Demographics
NPI:1962048355
Name:GRATTAN, JOSHUA (PHARM D)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:GRATTAN
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 1:3215 TURNBERRY
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-2323
Mailing Address - Country:US
Mailing Address - Phone:734-945-8173
Mailing Address - Fax:
Practice Address - Street 1:2907 KRAFFT RD
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-8628
Practice Address - Country:US
Practice Address - Phone:810-987-6346
Practice Address - Fax:810-987-6027
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2019-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020373501835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist