Provider Demographics
NPI:1558458323
Name:GRACEY, JERALD CRAIG (RPH)
Entity Type:Individual
Prefix:MR
First Name:JERALD
Middle Name:CRAIG
Last Name:GRACEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31303 ANTONIA LN
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4163
Mailing Address - Country:US
Mailing Address - Phone:281-351-1312
Mailing Address - Fax:
Practice Address - Street 1:28520 TOMBALL PKWY
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4546
Practice Address - Country:US
Practice Address - Phone:281-351-1972
Practice Address - Fax:281-351-9216
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25559183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist