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General NPI Number Information
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NPI Number | 1386657583
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Entity Type | Individual
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Provider Name | GREGORY RAY STEWART R.PH.
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Gender | Male
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 209 W MORGAN AVE
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City | PENNINGTON GAP
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State | VA
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Zip | 24277-2315
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Country | US
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Telephone | 276-546-1551
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 183
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City | BEN HUR
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State | VA
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Zip | 24218-0183
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Country | US
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Telephone | 276-346-4166
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0202005288
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License Number State | VA
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