Provider Demographics
NPI:1497084123
Name:GRACIA, NICHOLAS BRIAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:BRIAN
Last Name:GRACIA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14505 NW MILITARY HWY
Mailing Address - Street 2:
Mailing Address - City:SHAVANO PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1629
Mailing Address - Country:US
Mailing Address - Phone:210-408-1019
Mailing Address - Fax:
Practice Address - Street 1:14505 NW MILITARY HWY
Practice Address - Street 2:
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78231-1629
Practice Address - Country:US
Practice Address - Phone:210-408-1019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43455183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist