Provider Demographics
NPI:1154841823
Name:GRADY, CHRISTOPHER BRYCE
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:BRYCE
Last Name:GRADY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 HWY 258 N
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-7223
Mailing Address - Country:US
Mailing Address - Phone:252-522-2200
Mailing Address - Fax:252-522-2202
Practice Address - Street 1:2202 HWY 258N
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-7223
Practice Address - Country:US
Practice Address - Phone:252-522-2200
Practice Address - Fax:252-522-2202
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26523183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist