Provider Demographics
NPI:1346535564
Name:GRADY, CHASTY PATRICE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHASTY
Middle Name:PATRICE
Last Name:GRADY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3867 PROMENADE PKWY
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-5372
Mailing Address - Country:US
Mailing Address - Phone:228-233-3302
Mailing Address - Fax:228-233-3312
Practice Address - Street 1:3867 PROMENADE PKWY
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-5372
Practice Address - Country:US
Practice Address - Phone:228-233-3302
Practice Address - Fax:228-233-3312
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE010568183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist