MEDICARE: VMC GRACE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	30786	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2159724	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356795678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VMC GRACE LLC

Provider Business Mailing Address
First Line	:	921 FM 1187 E STE A
Second Line	:
City	:	CROWLEY
State	:	TX
Zip	:	76036-4364
Country	:	US
Telephone Number	:	817-297-2000
Fax Number	:	817-297-2010

Provider Business Practice Location Address
First Line	:	921 FM 1187 E STE A
Second Line	:
City	:	CROWLEY
State	:	TX
Zip	:	76036-4364
Country	:	US
Telephone Number	:	817-297-2000
Fax Number	:	817-297-2010

Authorized Official
Title or Position	:	OWNER, PIC, AO
Name	:	MAGGIE MANKARIOUS
Credential	:	RPH
Telephone Number	:	682-234-2309

Provider Enumeration Date	:	04/22/2016
Last Update Date	:	09/19/2025

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Directions to “VMC GRACE LLC ” Practice Location

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