Provider Demographics
NPI:1649215179
Name:GRACE HEALTHCARE SOLUTIONS INC
Entity Type:Organization
Organization Name:GRACE HEALTHCARE SOLUTIONS INC
Other - Org Name:SAN DIMAS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIH-PING
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:909-599-8369
Mailing Address - Street 1:1330 W COVINA BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773
Mailing Address - Country:US
Mailing Address - Phone:909-599-8369
Mailing Address - Fax:909-599-8360
Practice Address - Street 1:1330 W COVINA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3200
Practice Address - Country:US
Practice Address - Phone:909-599-8369
Practice Address - Fax:909-599-8360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X, 3336C0003X
CAPHY436523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1649215179Medicaid
CAPHY57952OtherBOARD OF PHARMACY
1990827OtherPK