# DIVINE GRACE PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Divine Grace Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164086245
- **Authorized official:** GRACE T GBADAMOSI BSC (OWNER/PHARMACIST)
- **Authorized official phone:** (430) 630-2600

## Contact information

- **Practice address:** 1970 US HIGHWAY 259 S \# 100, DIANA, TX 75640-4037
- **Practice address phone:** (430) 625-2600
- **Practice address fax:** (430) 625-2600
- **Mailing address:** 2058 ROSEBURY LN, FORNEY, TX 75126-0917
- **Mailing address phone:** (903) 445-7306

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1835P0018X | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | — | — | Yes |

## Other

- **Enumeration date:** 04/24/2019
- **Last updated:** 04/24/2019