Provider Demographics
NPI:1114557519
Name:GRAY, PHILLIP RYAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:RYAN
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 1:14930 MAJESTIC CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23834-6814
Mailing Address - Country:US
Mailing Address - Phone:540-397-2208
Mailing Address - Fax:
Practice Address - Street 1:2821 HICKS ROAD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-0000
Practice Address - Country:US
Practice Address - Phone:804-675-4519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022159481835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist