Provider Demographics
NPI:1164294245
Name:GRACE PHARMACY
Entity Type:Organization
Organization Name:GRACE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:SEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:502-424-4133
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:BURNSIDE
Mailing Address - State:KY
Mailing Address - Zip Code:42519-0384
Mailing Address - Country:US
Mailing Address - Phone:606-425-4051
Mailing Address - Fax:606-425-4177
Practice Address - Street 1:546 PARKERS MILL RD
Practice Address - Street 2:UNIT B
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501
Practice Address - Country:US
Practice Address - Phone:606-425-4051
Practice Address - Fax:606-425-4177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy