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Gracelight Community Health
Clinic Pharmacy in Los Angeles, California
NPI 1952716441

Gracelight Community Health is a Clinic Pharmacy based in Los Angeles, CA and is specialized in Clinic Pharmacy. Gracelight Community Health practices in Los Angeles, CA. The NPI Number for Gracelight Community Health is 1952716441 and holds a License No. (California).

The current practice location address for Gracelight Community Health is 4618 Fountain Ave, Los Angeles, CA and can be reached out via phone at 323-953-7170 and via fax at 323-669-2379.

Location: 4618 Fountain Ave, Los Angeles, CA, 90022-1602
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1952716441
Provider Name
Gracelight Community Health
Credential
Provider Entity Type
Organization
Address
4618 Fountain Ave, Los Angeles, CA, 90022-1602
Phone Number
323-953-7170
Fax Number
323-669-2379
Provider Enumeration Date
06/24/2014
Last Update Date
07/20/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
55-1895 01 CA MEDICARE FQHC PROVIDER NUMBER
CMM70660F 05 CA
FHC70660F 01 CA MEDI-CAL FQHC PROVIDER NUMBER
W6997D 01 CA MEDICARE PROVIDER NUMBER
institution
Provider Business Practice Location Address Details
Address
4618 Fountain Ave
City
Los Angeles
State
California
Zip
90029-1977
Phone Number
323-953-7170
Fax Number
323-669-2379
person
Provider Business Mailing Address Details
Address
4618 Fountain Ave
City
Los Angeles
State
California
Zip
90029-1977
Phone Number
323-953-7170
Fax Number
323-669-2379
person
Provider's Taxonomy Details 1
Type
Suppliers
Classification
Pharmacy
Speciality
-
Taxonomy
333600000X
License No.
()
Definition
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.
person
Provider's Taxonomy Details 2
Type
Suppliers
Classification
Pharmacy
Speciality
Clinic Pharmacy
Taxonomy
3336C0002X
License No.
()
Definition
A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist.
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