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NPI Code Detail

MEDICARE: KRISTINE GRAY

MEDICARE: KRISTINE GRAY
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
1183500000XPharmacist9464622-1701UT

General Provider Information

NPI Number : 1982296422
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTINE GRAY
Provider Business Mailing Address
First Line : 1269 E 2100 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-2824
Country : US
Telephone Number : 801-486-0695
Fax Number :
Provider Business Practice Location Address
First Line : 1269 E 2100 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-2824
Country : US
Telephone Number : 801-486-0695
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2021
Last Update Date : 02/05/2021

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Directions to “ KRISTINE GRAY ” Practice Location

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