Organization
PADAGRACE LLC
Active
Other names
GRACELINE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
PRISCILLA OKPUZOR (OWNER/PIC)
(832) 758-4655
Entity
Organization
Contact information
Practice address
5800 BELLAIRE BLVD BLDG 1, HOUSTON, TX 77081-5537
(713) 838-8899
(713) 838-8895
Mailing address
5800 BELLAIRE BLVD, BLD. 1 STE. 108, HOUSTON, TX 77081-5537
(713) 838-8899
(713) 838-8895
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4554603
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/07/2009
Last updated
05/09/2011
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