Provider Demographics
NPI:1851394779
Name:PACE, GRADY LOY JR (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:GRADY
Middle Name:LOY
Last Name:PACE
Suffix:JR
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:515 HARTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3426
Mailing Address - Country:US
Mailing Address - Phone:318-473-0924
Mailing Address - Fax:318-473-2772
Practice Address - Street 1:1806 WATER ST
Practice Address - Street 2:
Practice Address - City:LECOMPTE
Practice Address - State:LA
Practice Address - Zip Code:71346
Practice Address - Country:US
Practice Address - Phone:318-776-5646
Practice Address - Fax:318-776-9212
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist