Provider Demographics
NPI:1114413705
Name:GRAY PHARM INCORPORATED
Entity Type:Organization
Organization Name:GRAY PHARM INCORPORATED
Other - Org Name:THE PHARMACY SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BARTHOLEMEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-323-2883
Mailing Address - Street 1:1510 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71202-2742
Mailing Address - Country:US
Mailing Address - Phone:318-323-2883
Mailing Address - Fax:318-323-2883
Practice Address - Street 1:1510 S 2ND ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-2742
Practice Address - Country:US
Practice Address - Phone:318-323-2883
Practice Address - Fax:318-323-2883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.007717-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy