Organization
NEW GRACE PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDUARD YAKUBOV PHARM D (SUPERVISING PHARMACIST)
(516) 472-7688
Entity
Organization
Contact information
Practice address
10 GRACE AVE, GREAT NECK, NY 11021-2447
(516) 472-7688
(516) 717-4199
Mailing address
10 GRACE AVE, GREAT NECK, NY 11021
(516) 472-7688
(516) 717-4199
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05082733
—
NY
Enumeration date
06/05/2017
Last updated
01/27/2022
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