Provider Demographics
NPI:1043731367
Name:GRAVITT, JERRY R (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:R
Last Name:GRAVITT
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 DAVIS RD UNIT C
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-7677
Mailing Address - Country:US
Mailing Address - Phone:919-801-8251
Mailing Address - Fax:
Practice Address - Street 1:1180 N BRIGHTLEAF BLVD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4228
Practice Address - Country:US
Practice Address - Phone:919-938-0591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23524183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist