Provider Demographics
NPI:1306227145
Name:GRACIEBRUTUS PHARMACY INC.
Entity Type:Organization
Organization Name:GRACIEBRUTUS PHARMACY INC.
Other - Org Name:GRACE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/PHARMACY MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALTAGRACIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUTUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-618-7927
Mailing Address - Street 1:205 E 198TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-3101
Mailing Address - Country:US
Mailing Address - Phone:718-618-7927
Mailing Address - Fax:718-618-7929
Practice Address - Street 1:205 E 198TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-3101
Practice Address - Country:US
Practice Address - Phone:718-618-7927
Practice Address - Fax:718-618-7929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI049563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty