Healthcare Provider Details

I. General information

NPI: 1821963539
Provider Name (Legal Business Name): CARL CHRISTIAN GRAY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 N MAIN ST
PAYSON UT
84651-1851
US

IV. Provider business mailing address

132 N MAIN ST
PAYSON UT
84651-1851
US

V. Phone/Fax

Practice location:
  • Phone: 801-465-0125
  • Fax: 801-465-9189
Mailing address:
  • Phone: 801-465-0125
  • Fax: 801-465-9189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9138117-1701
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: