Provider Demographics
NPI:1003884248
Name:GRAY DRUG CO INC
Entity Type:Organization
Organization Name:GRAY DRUG CO INC
Other - Org Name:GRAY DRUG COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:478-986-3161
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:GA
Mailing Address - Zip Code:31032-0490
Mailing Address - Country:US
Mailing Address - Phone:478-986-3161
Mailing Address - Fax:478-986-5056
Practice Address - Street 1:157 BILL CONN PKWY
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:GA
Practice Address - Zip Code:31032-6349
Practice Address - Country:US
Practice Address - Phone:478-986-3161
Practice Address - Fax:478-986-5056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0006353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000028531AMedicaid
2012387OtherPK
0740080002Medicare NSC