Healthcare Provider Details

I. General information

NPI: 1174273114
Provider Name (Legal Business Name): GOOD GRACES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

857 E MAIN ST STE 3
WILLOW SPRINGS MO
65793-1500
US

IV. Provider business mailing address

857 E MAIN ST STE 3
WILLOW SPRINGS MO
65793-1500
US

V. Phone/Fax

Practice location:
  • Phone: 417-855-1085
  • Fax: 417-855-1086
Mailing address:
  • Phone: 417-855-1085
  • Fax: 417-855-1086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. BRANDON GREGORY
Title or Position: CO-OWNER, PRESIDENT
Credential:
Phone: 417-855-1085