Provider Demographics
NPI:1851699953
Name:G & H RAPHA,LLC
Entity Type:Organization
Organization Name:G & H RAPHA,LLC
Other - Org Name:GRACE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/PIC
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:909-839-0001
Mailing Address - Street 1:18777 COLIMA RD
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2949
Mailing Address - Country:US
Mailing Address - Phone:909-839-0001
Mailing Address - Fax:626-474-2053
Practice Address - Street 1:18777 COLIMA RD
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-2949
Practice Address - Country:US
Practice Address - Phone:909-839-0001
Practice Address - Fax:626-474-2053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5521660004Medicare NSC