Provider Demographics
NPI:1821717695
Name:GRACE & VICTORIA LLC
Entity Type:Organization
Organization Name:GRACE & VICTORIA LLC
Other - Org Name:GRACE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:832-991-1648
Mailing Address - Street 1:9212 FRY RD STE 135
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-5489
Mailing Address - Country:US
Mailing Address - Phone:832-626-2788
Mailing Address - Fax:832-831-8086
Practice Address - Street 1:9212 FRY RD STE 135
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-5489
Practice Address - Country:US
Practice Address - Phone:832-626-2788
Practice Address - Fax:832-831-8086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy