Provider Demographics
NPI:1700043676
Name:GRACE, MARCY RENEE (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:MARCY
Middle Name:RENEE
Last Name:GRACE
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 QUAIL RUN RD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:KY
Mailing Address - Zip Code:40336-9355
Mailing Address - Country:US
Mailing Address - Phone:606-723-9837
Mailing Address - Fax:
Practice Address - Street 1:1220 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-7232
Practice Address - Country:US
Practice Address - Phone:606-723-5315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY380101061152933183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician