Healthcare Provider Details

I. General information

NPI: 1063074235
Provider Name (Legal Business Name): BRIANA GRAY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 6TH AVE N INTERNAL MEDICINE
SAINT CLOUD MN
56303-2735
US

IV. Provider business mailing address

1200 6TH AVE N INTERNAL MEDICINE
SAINT CLOUD MN
56303-2735
US

V. Phone/Fax

Practice location:
  • Phone: 320-240-2203
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number123295
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: