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General NPI Number Information
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NPI Number | 1144303264
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Entity Type | Organization
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Legal Business Name | GRACE CLINIC OF LUBBOCK
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 4515 MARSHA SHARP FWY
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City | LUBBOCK
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State | TX
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Zip | 79407-2520
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Country | US
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Telephone | 806-740-3305
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Fax | 806-712-1803
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Provider Business Mailing Address
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Address Line | PO BOX 676132
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City | DALLAS
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State | TX
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Zip | 75267-6132
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Country | US
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Telephone | 806-740-3305
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Fax | 806-712-1803
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Authorized Official
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Title or Position | ASSISTANT SECRETARY OF ENROLLMENTS
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Name | DONALD WAYNE ANDERSON JR.
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Credential |
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Telephone | 425-358-9786
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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 | 25283
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License Number State | TX
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