Provider Demographics
NPI:1255938478
Name:GRACIA, JOSEPH A
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:A
Last Name:GRACIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 SCHOOL ST # 287
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-2826
Mailing Address - Country:US
Mailing Address - Phone:707-363-1607
Mailing Address - Fax:707-230-5566
Practice Address - Street 1:592 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3611
Practice Address - Country:US
Practice Address - Phone:707-363-1607
Practice Address - Fax:707-230-5566
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108098183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician