Jordan Malik Grant

NPI #1124893474 in Champaign, Illinois

Provider Information

NPI Number: 1124893474
Entity Type: Individual
Name: Jordan Malik Grant
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Pharmacist
Enumeration Date: Nov 16, 2023
Last Updated: Nov 16, 2023

Practice Location

Address: 1713 W SPRINGFIELD AVE
City: Champaign
State: Illinois
ZIP Code: 61821-3011
Phone: (217) 356-2529

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacist	183500000X	Primary

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