Healthcare Provider Details

I. General information

NPI: 1487128450
Provider Name (Legal Business Name): GRACE HEALTH PHARMACY-MANCHESTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 05/29/2025
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 HIGHWAY 80
MANCHESTER KY
40962-8801
US

IV. Provider business mailing address

85 HIGHWAY 80
MANCHESTER KY
40962-8801
US

V. Phone/Fax

Practice location:
  • Phone: 606-596-0410
  • Fax: 606-596-0051
Mailing address:
  • Phone: 606-596-0410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAVID CASEY WHITTAKER
Title or Position: DIRECTOR OF PHARMACY
Credential: PHARMD
Phone: 606-526-9005