Organization
GRACE RX PHARMACY INC
Active
Other names
GRACE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MADLEN BASILYAN PHARM D (PRESIDENT/CEO)
(818) 957-5555
Entity
Organization
Contact information
Practice address
1724 E WASHINGTON BLVD, PASADENA, CA 91104-2751
(818) 957-5555
(818) 957-5551
Mailing address
1724 E WASHINGTON BLVD, PASADENA, CA 91104-2751
(818) 957-5555
(818) 957-5551
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHY59258
BOARD OF PHARMACY
CA
Enumeration date
08/15/2012
Last updated
12/22/2023
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