Healthcare Provider Details

I. General information

NPI: 1992106082
Provider Name (Legal Business Name): GRACELIGHT COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4816 E 3RD ST
LOS ANGELES CA
90022-1602
US

IV. Provider business mailing address

4816 E 3RD ST
LOS ANGELES CA
90022-1602
US

V. Phone/Fax

Practice location:
  • Phone: 323-780-4510
  • Fax: 323-780-6132
Mailing address:
  • Phone: 323-635-1153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARINA SNITMAN
Title or Position: CHIEF OPERATING OFFICER
Credential: PHARMD
Phone: 323-635-1153