Provider Demographics
NPI:1851693881
Name:AMAZING GRACE PHARMACY, INC
Entity Type:Organization
Organization Name:AMAZING GRACE PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:O
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-230-0169
Mailing Address - Street 1:1965 TEXAS PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-3121
Mailing Address - Country:US
Mailing Address - Phone:832-230-0169
Mailing Address - Fax:832-230-0252
Practice Address - Street 1:1965 TEXAS PKWY
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-3121
Practice Address - Country:US
Practice Address - Phone:832-230-0169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty