Provider Demographics
NPI:1144822123
Name:TO, GRACE LEEWAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:LEEWAN
Last Name:TO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:GRACE
Other - Middle Name:LEEWAN
Other - Last Name:TO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:26 BROOKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-1215
Mailing Address - Country:US
Mailing Address - Phone:401-486-1502
Mailing Address - Fax:
Practice Address - Street 1:160 BROADWAY
Practice Address - Street 2:
Practice Address - City:RAYNHAM
Practice Address - State:MA
Practice Address - Zip Code:02767-1414
Practice Address - Country:US
Practice Address - Phone:508-692-6751
Practice Address - Fax:508-692-6751
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH05804183500000X
MAPH237659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist