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General NPI Number Information
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NPI Number | 1871547919
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Entity Type | Organization
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Legal Business Name | GRAYLING PHARMACY INC
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 208 E MICHIGAN AVE
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City | GRAYLING
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State | MI
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Zip | 49738
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Country | US
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Telephone | 989-348-6688
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Fax | 989-348-1895
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Provider Business Mailing Address
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Address Line | 208 E MICHIGAN AVE
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City | GRAYLING
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State | MI
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Zip | 49738
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Country | US
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Telephone | 989-348-6688
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Fax | 989-348-1895
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Authorized Official
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Title or Position | PHARMICIST OWNER
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Name | MR. JEFFREY BRUCE EMMONS
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Credential | RPH
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Telephone | 989-348-6688
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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 | 5301006615
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License Number State | MI
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