Emilio Grandez, RPH

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

029002 Issued in GA

Practice address

3785 Sixes Rd
Canton, GA 30114-7809

Phone

(770) 720-3466

NPI assigned

Dec 3, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606953600000",
    "number": "1033714365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 MISTY VALLEY DR",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301147732",
            "telephone_number": "617-459-6449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3785 SIXES RD",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301147809",
            "telephone_number": "770-720-3466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANDEZ",
        "first_name": "EMILIO",
        "name_prefix": "Dr.",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-12-03",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "029002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVER'S LICENSE",
            "identifier": "060005303",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Canton",
            "affiliation": "N",
            "address_1": "3785 Sixes Rd",
            "city": "Canton",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301147809",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Goshen Valley Foundation Inc
• Venu Gourineni, MD
• Keasha Grace
• Alison Elizabeth Graf
• Susan Michele Gramling, PHARMD
• Anitra Simone Graves, M.D.
• Elizabeth Graves, LCSW
• Wendy Renee Greco, OTR/L
• Andrea Jai Green, PHARMD
• Catherine Larsen Green, PA

• Community/Retail Pharmacy in Canton, GA
• Providers in Canton, GA by specialty
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.