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General NPI Number Information
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NPI Number | 1659970184
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Entity Type | Organization
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Legal Business Name | GRACEE PHARMACY PLLC
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 01/24/2021
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Provider Practice Location Address
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Address Line | 1338 N TELEGRAPH RD
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City | DEARBORN
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State | MI
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Zip | 48128-1204
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Country | US
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Telephone | 313-733-4523
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Fax | 313-305-7375
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Provider Business Mailing Address
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Address Line | 1338 N TELEGRAPH RD
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City | DEARBORN
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State | MI
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Zip | 48128-1204
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Country | US
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Telephone | 313-733-4523
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Fax | 313-305-7375
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Authorized Official
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Title or Position | PIC
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Name | ISAIAH OKOH
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Credential | RPH
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Telephone | 313-733-4523
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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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