Provider Demographics
NPI:1396498697
Name:PHARMACY OF GRACE INC.
Entity type:Organization
Organization Name:PHARMACY OF GRACE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:FINK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:913-244-9409
Mailing Address - Street 1:721 N 31ST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-3972
Mailing Address - Country:US
Mailing Address - Phone:913-953-8260
Mailing Address - Fax:913-953-8268
Practice Address - Street 1:721 N 31ST ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-3962
Practice Address - Country:US
Practice Address - Phone:913-953-8260
Practice Address - Fax:913-953-8268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-27
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004794680001Medicaid