Provider Demographics
NPI:1164851234
Name:GRASSO ENTERPRISES LLC
Entity type:Organization
Organization Name:GRASSO ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GRASSO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:830-257-0732
Mailing Address - Street 1:1228 BANDERA HWY
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-9640
Mailing Address - Country:US
Mailing Address - Phone:830-257-0732
Mailing Address - Fax:830-257-8486
Practice Address - Street 1:1228 BANDERA HWY
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-9640
Practice Address - Country:US
Practice Address - Phone:830-257-0732
Practice Address - Fax:830-257-8486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336S0011X
TX288713336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy