1942226568 NPI number — GRAY PHARMACY

Table of content: (NPI 1942226568)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942226568 NPI number — GRAY PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRAY PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942226568
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 8012
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37615-0012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-477-2800
Provider Business Mailing Address Fax Number:
423-477-2804

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 SUNCREST ST
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
GRAY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37615-3494
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-477-2800
Provider Business Practice Location Address Fax Number:
423-477-2804
Provider Enumeration Date:
07/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOWE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
423-477-2800

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0000000860 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0149630001 . This is a "MEDICARE ID" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010228115 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0149630001 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0149630001 . This is a "MEDICARE ID" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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