Healthcare Provider Details

I. General information

NPI: 1841100443
Provider Name (Legal Business Name): TREYSEN CHARLES EDWARD GRAY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N BLUFF ST
FULTON MO
65251-2499
US

IV. Provider business mailing address

1701 N BLUFF ST
FULTON MO
65251-2499
US

V. Phone/Fax

Practice location:
  • Phone: 573-642-9255
  • Fax: 573-642-5596
Mailing address:
  • Phone: 573-642-9255
  • Fax: 573-642-5596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2026040896
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: