Provider Demographics
NPI:1093732976
Name:GRACE PHARMACY LTD.
Entity Type:Organization
Organization Name:GRACE PHARMACY LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YANIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVARADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-963-3911
Mailing Address - Street 1:491 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-3252
Mailing Address - Country:US
Mailing Address - Phone:914-963-3911
Mailing Address - Fax:914-963-7715
Practice Address - Street 1:491 S BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-3252
Practice Address - Country:US
Practice Address - Phone:914-963-3911
Practice Address - Fax:914-963-7715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01155366Medicaid
NY01155366Medicaid