Healthcare Provider Details

I. General information

NPI: 1386080539
Provider Name (Legal Business Name): MS. JENNIFER ELIZABETH GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N LEMON AVE
WALNUT CA
91789-2345
US

IV. Provider business mailing address

350 N LEMON AVE
WALNUT CA
91789-2345
US

V. Phone/Fax

Practice location:
  • Phone: 909-348-3973
  • Fax:
Mailing address:
  • Phone: 909-595-7431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH75263
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: