Provider Demographics
NPI:1447527015
Name:GRAMER, JEANINE
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:
Last Name:GRAMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3339 LAS VEGAS BLVD S
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-1401
Mailing Address - Country:US
Mailing Address - Phone:702-369-8166
Mailing Address - Fax:
Practice Address - Street 1:3339 LAS VEGAS BLVD S
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1401
Practice Address - Country:US
Practice Address - Phone:702-369-8166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17697183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist