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General NPI Number Information
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NPI Number | 1043829658
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Entity Type | Organization
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Legal Business Name | GRAPEVINE PHARMACY, INC
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Dates
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Enumeration Date | 07/29/2020
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Last Update Date | 07/29/2020
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Provider Practice Location Address
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Address Line | 2637 IRA E WOODS AVE STE 200
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City | GRAPEVINE
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State | TX
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Zip | 76051-9012
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Country | US
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Telephone | 817-416-2222
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Fax | 817-416-2223
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Provider Business Mailing Address
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Address Line | 2637 IRA E WOODS AVE STE 200
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City | GRAPEVINE
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State | TX
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Zip | 76051-9012
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Country | US
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Telephone | 817-416-2222
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Fax | 817-416-2223
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Authorized Official
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Title or Position | OWNER
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Name | NATALIE BENITEZ
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Credential | CPHT
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Telephone | 469-733-0606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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