Healthcare Provider Details

I. General information

NPI: 1609790625
Provider Name (Legal Business Name): JARON GRAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2988 WALKER AVE NW
GRAND RAPIDS MI
49544-9424
US

IV. Provider business mailing address

14161 NEW MILLPOND RD
BIG RAPIDS MI
49307-8911
US

V. Phone/Fax

Practice location:
  • Phone: 616-735-5070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302419075
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: