Granger Clinic Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

61710311703 Issued in UT

Legal business name

GRANGER CLINIC PHARMACY INC

Practice address

3725 W 4100 S
West Valley City, UT 84120-5530

Phone

(801) 965-3639

Fax

(801) 965-9641

NPI assigned

Aug 10, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Melissa Young

Title

Owner

Phone

(801) 965-3639

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780695338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3725 W 4100 S",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841205530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3725 W 4100 S",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841205530",
            "telephone_number": "801-965-3639",
            "fax_number": "801-965-9641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANGER CLINIC PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-965-3639"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "UT",
            "license": "61710311703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "4610502",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gloria Raychel Gonzales, MD
• Maria Alejandra Gonzalez Ferrua, MD
• Alejandro Esteban Gonzalez
• Phoebe A Grace
• Kathryn Graham
• Granger Medical Clinic (Jon Richard Aoki)
• Granger Medical Clinic PC
• Granger Medical Clinic, PC
• Granger Medical Specialists LLC
• Granger Optical LLC

• Community/Retail Pharmacy in West Valley City, UT
• Providers in West Valley City, UT by specialty
• Community/Retail Pharmacy in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.