Provider Demographics
NPI:1003139205
Name:GRACIA, KETTY (RPH)
Entity Type:Individual
Prefix:MS
First Name:KETTY
Middle Name:
Last Name:GRACIA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-2305
Mailing Address - Country:US
Mailing Address - Phone:914-831-9446
Mailing Address - Fax:
Practice Address - Street 1:275 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-2602
Practice Address - Country:US
Practice Address - Phone:914-381-4550
Practice Address - Fax:914-381-2521
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042743183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist