Healthcare Provider Details

I. General information

NPI: 1912298514
Provider Name (Legal Business Name): GRADY SAXTON JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 CENTURY PARKWAY
MEMPHIS TN
38134
US

IV. Provider business mailing address

1640 CENTURY PARKWAY
MEMPHIS TN
38134
US

V. Phone/Fax

Practice location:
  • Phone: 800-803-2523
  • Fax:
Mailing address:
  • Phone: 800-803-2523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12765
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: