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General NPI Number Information
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NPI Number | 1003884248
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Entity Type | Organization
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Legal Business Name | GRAY DRUG CO INC
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | 157 BILL CONN PKWY
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City | GRAY
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State | GA
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Zip | 31032-6349
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Country | US
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Telephone | 478-986-3161
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Fax | 478-986-5056
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Provider Business Mailing Address
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Address Line | PO BOX 490
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City | GRAY
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State | GA
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Zip | 31032-0490
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Country | US
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Telephone | 478-986-3161
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Fax | 478-986-5056
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Authorized Official
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Title or Position | PRESIDENT
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Name | DOROTHY WALKER
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Credential | PHARM D
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Telephone | 478-986-3161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE000635
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License Number State | GA
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