MEDICARE: GRETCHEN STEFFEY GRAY PHARMD

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	183500000X	Pharmacist	025239	GA

General Provider Information

NPI Number	:	1952686487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETCHEN STEFFEY GRAY PHARMD

Provider Business Mailing Address
First Line	:	3700 MACON RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-2248
Country	:	US
Telephone Number	:	706-568-6878
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 MACON RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-2248
Country	:	US
Telephone Number	:	706-568-6878
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2011
Last Update Date	:	10/16/2011

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