Organization
GRACIOUS HEALTH MART LLC
Active
Other names
Mass Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KRYSTAL MIMS (OWNER)
(334) 819-4500
Entity
Organization
Contact information
Practice address
4237 SALISBURY RD BLDG 3, JACKSONVILLE, FL 32216-8029
(904) 683-4298
Mailing address
3480 EASTERN BLVD, MONTGOMERY, AL 36116-1700
(334) 819-4500
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113393600
—
FL
Enumeration date
05/07/2019
Last updated
02/19/2026
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