Provider Demographics
NPI:1316576770
Name:GRAYS, SHETERIA NECOLE (CPHT)
Entity Type:Individual
Prefix:
First Name:SHETERIA
Middle Name:NECOLE
Last Name:GRAYS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 BRUCE ST
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-5206
Mailing Address - Country:US
Mailing Address - Phone:601-347-3674
Mailing Address - Fax:
Practice Address - Street 1:2209 HIGHWAY 11 N
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-2065
Practice Address - Country:US
Practice Address - Phone:601-799-2087
Practice Address - Fax:601-799-2971
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT-07621183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician