MEDICARE: GAYNELL H SMITH-GRAY RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202006618	VA

General Provider Information

NPI Number	:	1114168259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAYNELL H SMITH-GRAY RPH

Provider Business Mailing Address
First Line	:	5 TAMERLANE DR
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-7737
Country	:	US
Telephone Number	:	540-657-9806
Fax Number	:	540-288-1996

Provider Business Practice Location Address
First Line	:	2812 E PARHAM RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-2918
Country	:	US
Telephone Number	:	804-264-6418
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2009
Last Update Date	:	03/19/2009

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