Provider Demographics
NPI:1023398351
Name:GRAY, ROBIN SCOTT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:SCOTT
Last Name:GRAY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3538 SPLIT RAIL LN
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-3831
Mailing Address - Country:US
Mailing Address - Phone:410-418-4754
Mailing Address - Fax:
Practice Address - Street 1:3538 SPLIT RAIL LN
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-3831
Practice Address - Country:US
Practice Address - Phone:410-418-4754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17652183500000X
FLPS 42159183500000X
TN29324183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist