Provider Demographics
NPI:1790385599
Name:SEGURA, GRACE (RPH)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:SEGURA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:GONZALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:4302 CONGRESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-2529
Mailing Address - Country:US
Mailing Address - Phone:361-774-9280
Mailing Address - Fax:
Practice Address - Street 1:1821 S PADRE ISLAND DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78416-1398
Practice Address - Country:US
Practice Address - Phone:361-854-5804
Practice Address - Fax:361-855-5937
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist