Provider Demographics
NPI:1982243499
Name:GRACE PHARMACY AND WELLNESS LLC
Entity Type:Organization
Organization Name:GRACE PHARMACY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:NWACHUKWU
Authorized Official - Last Name:ALIGWEKWE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:470-508-0555
Mailing Address - Street 1:913 AUTUMN PATH WAY
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-7752
Mailing Address - Country:US
Mailing Address - Phone:470-508-0555
Mailing Address - Fax:
Practice Address - Street 1:4404 HUGH HOWELL RD STE 17
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4916
Practice Address - Country:US
Practice Address - Phone:470-508-0555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy