MEDICARE: GREY & TEAL

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	333600000X	Pharmacy

General Provider Information

NPI Number	:	1033686175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREY & TEAL

Provider Business Mailing Address
First Line	:	7910 US HIGHWAY 117 S UNIT 110
Second Line	:
City	:	ROCKY POINT
State	:	NC
Zip	:	28457-7409
Country	:	US
Telephone Number	:	910-210-2030
Fax Number	:	910-210-2031

Provider Business Practice Location Address
First Line	:	7910 US HIGHWAY 117 S UNIT 110
Second Line	:
City	:	ROCKY POINT
State	:	NC
Zip	:	28457-7409
Country	:	US
Telephone Number	:	910-210-2030
Fax Number	:	910-210-2031

Authorized Official
Title or Position	:	PRESIDENT/MANGER
Name	:	ELIZABETH T LOCKLEAR
Credential	:
Telephone Number	:	910-210-2030

Provider Enumeration Date	:	10/26/2018
Last Update Date	:	01/16/2019

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1629691555 — GREY & TEAL
Practice Location Address:

7910 US HWY 117 S UNIT 110
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28457-7409

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Practice Fax:

Directions to “GREY & TEAL ” Practice Location

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