Healthcare Provider Details

I. General information

NPI: 1881697480
Provider Name (Legal Business Name): STEVE GRAY PHARM D, RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 GALL ST
LOWER BRULE SD
57548
US

IV. Provider business mailing address

401 N HARRISON AVE
PIERRE SD
57501-2616
US

V. Phone/Fax

Practice location:
  • Phone: 605-473-8226
  • Fax: 605-473-0708
Mailing address:
  • Phone: 605-224-0789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberR-5129
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302029104
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: