Provider Demographics
NPI:1831435668
Name:DR GRAM PHARMACY INC
Entity type:Organization
Organization Name:DR GRAM PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAMLICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-741-9804
Mailing Address - Street 1:911 E VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3428
Mailing Address - Country:US
Mailing Address - Phone:760-480-1871
Mailing Address - Fax:760-480-6317
Practice Address - Street 1:911 E VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3428
Practice Address - Country:US
Practice Address - Phone:760-480-1871
Practice Address - Fax:760-480-6317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CA510953336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5646154OtherNCPDP PROVIDER IDENTIFICATION NUMBER