MEDICARE: GREY PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy		MD

General Provider Information

NPI Number	:	1023515640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREY PHARMACY LLC

Provider Business Mailing Address
First Line	:	12447 LOFT LN
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-6604
Country	:	US
Telephone Number	:	240-593-3015
Fax Number	:

Provider Business Practice Location Address
First Line	:	6201 GREENBELT RD STE M9
Second Line	:
City	:	BERWYN HEIGHTS
State	:	MD
Zip	:	20740-2358
Country	:	US
Telephone Number	:	240-593-3015
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. FISSEHA AMARE LILAY
Credential	:	PHARM-D
Telephone Number	:	240-593-3015

Provider Enumeration Date	:	04/10/2018
Last Update Date	:	06/16/2018

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