Provider Demographics
NPI:1225226319
Name:GRAY, JAMIE SHAW (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:SHAW
Last Name:GRAY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:MRS
Other - First Name:JAMIE
Other - Middle Name:SHAW
Other - Last Name:MARKSBURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 N LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:HODGENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42748-1610
Mailing Address - Country:US
Mailing Address - Phone:270-358-3186
Mailing Address - Fax:270-358-0926
Practice Address - Street 1:913 N DIXIE AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2503
Practice Address - Country:US
Practice Address - Phone:270-706-1256
Practice Address - Fax:270-706-1258
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012712183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist