Healthcare Provider Details

I. General information

NPI: 1750001186
Provider Name (Legal Business Name): SUSAN GREY PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 S MAIN ST
JAMESTOWN NY
14701-6633
US

IV. Provider business mailing address

8326 REED HILL RD
CATTARAUGUS NY
14719-9640
US

V. Phone/Fax

Practice location:
  • Phone: 716-664-2650
  • Fax:
Mailing address:
  • Phone: 716-397-9442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number021700
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number068769
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: