Provider Demographics
NPI:1164308367
Name:YOUN, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:YOUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 CREST DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07647-1324
Mailing Address - Country:US
Mailing Address - Phone:847-873-5173
Mailing Address - Fax:
Practice Address - Street 1:459 E 149TH ST STE A104
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-1789
Practice Address - Country:US
Practice Address - Phone:973-255-9699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03722900183500000X
NY064042-01183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist