Provider Demographics
NPI:1811184468
Name:GRASSO ENTERPRISES LLC
Entity type:Organization
Organization Name:GRASSO ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:GRASSO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:830-981-4774
Mailing Address - Street 1:31007 INTERSTATE 10 W
Mailing Address - Street 2:ST 108
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-9264
Mailing Address - Country:US
Mailing Address - Phone:830-981-4774
Mailing Address - Fax:830-981-4775
Practice Address - Street 1:31007 INTERSTATE 10 W
Practice Address - Street 2:ST 108
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-9264
Practice Address - Country:US
Practice Address - Phone:830-981-4774
Practice Address - Fax:830-981-4775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 333600000X
TX256783336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2101204OtherPK