Healthcare Provider Details

I. General information

NPI: 1871067785
Provider Name (Legal Business Name): GRACE FAMILY PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 S WILLIAM ST STE 3
NEWBURGH NY
12550-5300
US

IV. Provider business mailing address

5 BAYBERRY LN
POUGHKEEPSIE NY
12603-4925
US

V. Phone/Fax

Practice location:
  • Phone: 845-569-4100
  • Fax: 845-562-4867
Mailing address:
  • Phone: 845-463-2322
  • Fax: 845-463-2322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. ALBERT Y LU
Title or Position: PRESIDENT
Credential:
Phone: 718-309-1641