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General NPI Number Information
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NPI Number | 1679919161
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Entity Type | Individual
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Provider Name | ALAN D GRAY RPH
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Gender | Male
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Dates
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Enumeration Date | 05/11/2013
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Last Update Date | 05/11/2013
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Provider Practice Location Address
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Address Line | 1510 US HIGHWAY 17 N
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City | WAUCHULA
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State | FL
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Zip | 33873-5002
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Country | US
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Telephone | 863-767-1062
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Fax | 863-773-3789
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Provider Business Mailing Address
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Address Line | 13308 HOLLOWBEND LN
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City | RIVERVIEW
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State | FL
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Zip | 33569-5759
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Country | US
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Telephone | 813-758-0981
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Fax | 813-409-3535
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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 | PS23115
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License Number State | FL
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