Healthcare Provider Details

I. General information

NPI: 1104542653
Provider Name (Legal Business Name): MICKIE GRAY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 HILL RD N
PICKERINGTON OH
43147-8666
US

IV. Provider business mailing address

1045 HILL RD N
PICKERINGTON OH
43147-8666
US

V. Phone/Fax

Practice location:
  • Phone: 614-759-2765
  • Fax: 614-522-5580
Mailing address:
  • Phone: 614-759-2765
  • Fax: 614-522-5580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03442303
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: