Provider Demographics
NPI:1114168259
Name:SMITH-GRAY, GAYNELL H (RPH)
Entity Type:Individual
Prefix:
First Name:GAYNELL
Middle Name:H
Last Name:SMITH-GRAY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 TAMERLANE DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7737
Mailing Address - Country:US
Mailing Address - Phone:540-657-9806
Mailing Address - Fax:540-288-1996
Practice Address - Street 1:2812 E PARHAM RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-2918
Practice Address - Country:US
Practice Address - Phone:804-264-6418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006618183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist