Grace Medical Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301010188 Issued in MI

Legal business name

GRACE MEDICAL PHARMACY LLC

Doing business as

Grace Medical Pharmacy LLC

Practice address

20805 Grand River Ave
Detroit, MI 48219-3919

Phone

(313) 255-2300

Fax

(313) 255-2307

NPI assigned

Sep 17, 2013

Last updated

Jun 8, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Muyiwa John Sule

Title

Pharmacist/President

Phone

(248) 346-4480

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• GRACE MEDICAL PHARMACY LLC Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Muyiwa John Sule, PHARM.D

  • Pharmacist
  • Detroit, MI
  • NPI 1508988338
  NPD

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

{
    "created_epoch": "1379376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654646400000",
    "number": "1457787921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20805 GRAND RIVER AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482193919",
            "telephone_number": "313-255-2300",
            "fax_number": "313-255-2307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20805 GRAND RIVER AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482193919",
            "telephone_number": "313-255-2300",
            "fax_number": "313-255-2307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE MEDICAL PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-17",
        "last_updated": "2022-06-08",
        "certification_date": "2022-06-08",
        "status": "A",
        "authorized_official_last_name": "SULE",
        "authorized_official_first_name": "MUYIWA JOHN",
        "authorized_official_title_or_position": "PHARMACIST/PRESIDENT",
        "authorized_official_telephone_number": "248-346-4480"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301010188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2142091",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1457787921",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GRACE MEDICAL PHARMACY LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GRACE MEDICAL PHARMACY LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Grace by Faith Senior Center LLC
• Grace Care Pharmacy LLC (Grace Care Pharmacy)
• Grace Family Health Center PC
• Grace Neonatologists PC
• Grace OB GYN PC
• Grace Realty LLC
• Grace University Medical Group
• Anna Gracia

• Community/Retail Pharmacy in Detroit, MI
• Providers in Detroit, MI by specialty
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2022; 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.