Provider Demographics
NPI:1942890157
Name:GRICE, ANTOINETTE (RPH)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:GRICE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 INTERSTATE 35 N
Mailing Address - Street 2:
Mailing Address - City:DEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:78016-4466
Mailing Address - Country:US
Mailing Address - Phone:830-663-5964
Mailing Address - Fax:
Practice Address - Street 1:175 INTERSTATE 35 N
Practice Address - Street 2:
Practice Address - City:DEVINE
Practice Address - State:TX
Practice Address - Zip Code:78016-4466
Practice Address - Country:US
Practice Address - Phone:830-663-5964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67717183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist