MEDICARE: CORRINA LEA GRAY PHARM D

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	PH00041377	WA

General Provider Information

NPI Number	:	1811066582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORRINA LEA GRAY PHARM D

Provider Business Mailing Address
First Line	:	209 W MAIN AVE
Second Line	:	PO BOX 43
City	:	RITZVILLE
State	:	WA
Zip	:	99169-1409
Country	:	US
Telephone Number	:	509-659-0250
Fax Number	:	509-659-1763

Provider Business Practice Location Address
First Line	:	209 W MAIN AVE
Second Line	:
City	:	RITZVILLE
State	:	WA
Zip	:	99169-1409
Country	:	US
Telephone Number	:	509-659-0250
Fax Number	:	509-659-1763

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	04/25/2017

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