Provider Demographics
NPI:1275652448
Name:GRAY, JENNIFER CLARK (RPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CLARK
Last Name: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 1:7405 ASH SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-5667
Mailing Address - Country:US
Mailing Address - Phone:775-982-5060
Mailing Address - Fax:775-982-5039
Practice Address - Street 1:2200 HARVARD WAY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-4004
Practice Address - Country:US
Practice Address - Phone:775-689-2211
Practice Address - Fax:775-689-2438
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14854183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV14854OtherPHARMACIST LICENSE