Provider Demographics
NPI:1295212124
Name:GRACEE PHARMACY PLLC
Entity Type:Organization
Organization Name:GRACEE PHARMACY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:ISAIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:OKOH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:313-733-4523
Mailing Address - Street 1:11825 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203-3575
Mailing Address - Country:US
Mailing Address - Phone:313-733-4523
Mailing Address - Fax:313-305-7375
Practice Address - Street 1:11825 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-3575
Practice Address - Country:US
Practice Address - Phone:313-733-4523
Practice Address - Fax:313-305-7375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010114303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy