Provider Demographics
NPI:1417105560
Name:HORNSBY, NANCY GRACE (RPH)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:GRACE
Last Name:HORNSBY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 W. CHICAGO BLVD
Mailing Address - Street 2:P.O. BOX 306
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286
Mailing Address - Country:US
Mailing Address - Phone:517-423-4420
Mailing Address - Fax:517-423-7610
Practice Address - Street 1:2655 W. CHICAGO BLVD
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286
Practice Address - Country:US
Practice Address - Phone:517-423-4420
Practice Address - Fax:517-423-7610
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302021869183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist