Provider Demographics
NPI:1033884770
Name:VMLC GRACE HULEN, LLC
Entity Type:Organization
Organization Name:VMLC GRACE HULEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANKARIOUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-234-2309
Mailing Address - Street 1:5505 S HULEN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-2200
Mailing Address - Country:US
Mailing Address - Phone:817-297-2000
Mailing Address - Fax:
Practice Address - Street 1:5505 S HULEN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-2200
Practice Address - Country:US
Practice Address - Phone:817-297-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy