| Doctor Name: | JENNIFER GRANT |
| NPI Number: | 1295058410 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RPH |
| License Number: | 20 046773 |
| Business Practice Address: | 29 East Main Street Gouverneur, NY - 13642 |
| Business Phone Number: | 3152875002 |
| Business Fax Number: | 1800898423 |
| Mailing Address: | 147 Church Street, HERMON |
| State: | NY |
| Postal Code: | 13652 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 03/02/2010 |
| NPI Last Update Date: | 03/02/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1835G0303X |
| License Number: | 20 046773 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacist |
| Taxonomy Specialization: | Geriatric |
| Taxonomy Definition: | A pharmacist who is certified in geriatric pharmacy practice is designated as a |