Grace Community Pharmacy, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

GRACE COMMUNITY PHARMACY, INC.

Practice address

4881 La Palma Ave.
La Palma, CA 90623

Phone

(562) 860-0586

Fax

(562) 860-0767

NPI assigned

Oct 8, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Minjung K. Park, RPH, PH.D.NPI 1780191312

Title

Pic

Phone

(562) 860-0586

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• GRACE COMMUNITY PHARMACY Other name

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Tax ID family

Grace Community Pharmacy Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Grace Community Pharmacy, Inc.

  • Long Term Care Pharmacy
  • La Palma, CA
  • NPI 1013726637
  NPD tax ID

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Grace Community Pharmacy, Inc.

  • Long Term Care Pharmacy
  • La Palma, CA
  • NPI 1013726637
  NPPES parent name

Practitioners 2

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

• Minjung K Park, PH.D.

  • Pharmacist
  • La Palma, CA
  • NPI 1780191312
  NPD Authorized official
• Sun Hui Kim, R.PH.

  • Pharmacist
  • La Palma, CA
  • NPI 1801949912
  NPD (past)

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

{
    "created_epoch": "1223424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667174400000",
    "number": "1801047964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4881 LA PALMA AVE.",
            "city": "LA PALMA",
            "state": "CA",
            "postal_code": "90623",
            "telephone_number": "562-860-0586",
            "fax_number": "562-860-0767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4881 LA PALMA AVE.",
            "city": "LA PALMA",
            "state": "CA",
            "postal_code": "90623",
            "telephone_number": "562-860-0586",
            "fax_number": "562-860-0767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE COMMUNITY PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-08",
        "last_updated": "2022-10-31",
        "certification_date": "2022-10-31",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "MINJUNG",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "562-860-0586",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "RPH, PH.D."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1801047964",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GRACE COMMUNITY PHARMACY",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Karina Gonzalez
• Madison Gonzalez
• Suszeth Gonzalez
• Shaliece Gosey
• Grace Community Pharmacy, Inc.
• Jessica Esmat Grace
• Shontae Grant-Nevels
• Israel Guereca
• Adrian Salvador Guerra
• Candace Ann Ramirez Guerrero

• Community/Retail Pharmacy in La Palma, CA
• Providers in La Palma, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.