Divine Grace Pharmacy LLC

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

Legal business name

DIVINE GRACE PHARMACY LLC

Practice address

1970 US Highway 259 S # 100
Diana, TX 75640-4037

Phone

(430) 625-2600

Fax

(430) 625-2600

NPI assigned

Apr 24, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Grace T Gbadamosi, BSCNPI 1942447198

Title

Owner/Pharmacist

Phone

(430) 630-2600

Specialties & licenses 1

Addresses

Other names 1

• Divine Grace Pharmacy Doing business as

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Grace Titilola Gbadamosi, RPH

  • Pharmacist
  • Diana, TX
  • NPI 1942447198
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1556064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556064000000",
    "number": "1164086245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2058 ROSEBURY LN",
            "city": "FORNEY",
            "state": "TX",
            "postal_code": "751260917",
            "telephone_number": "903-445-7306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1970 US HIGHWAY 259 S # 100",
            "city": "DIANA",
            "state": "TX",
            "postal_code": "756404037",
            "telephone_number": "430-625-2600",
            "fax_number": "430-625-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE GRACE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-24",
        "last_updated": "2019-04-24",
        "status": "A",
        "authorized_official_last_name": "GBADAMOSI",
        "authorized_official_first_name": "GRACE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER/PHARMACIST",
        "authorized_official_telephone_number": "430-630-2600",
        "authorized_official_credential": "BSC"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "grace@divinegracerx.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1970 US Highway 259 S # 100",
            "city": "Diana",
            "state": "TX",
            "country_code": "US",
            "postal_code": "756404037",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Divine Grace Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Makenzie Marie Benoit, OTA
• Michele Cook, RDN
• Jennifer Kay Dyess
• Grace Titilola Gbadamosi, RPH
• Martina Janee Godwin James
• Sheryl Renee Handlin, OM
• Tara Shey Johnson

• All providers in Diana, TX
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.