Provider Demographics
NPI:1386657583
Name:STEWART, GREGORY RAY (RPH)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:RAY
Last Name:STEWART
Suffix:
Gender:M
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:PO BOX 183
Mailing Address - Street 2:
Mailing Address - City:BEN HUR
Mailing Address - State:VA
Mailing Address - Zip Code:24218-0183
Mailing Address - Country:US
Mailing Address - Phone:276-346-4166
Mailing Address - Fax:
Practice Address - Street 1:209 W MORGAN AVE
Practice Address - Street 2:
Practice Address - City:PENNINGTON GAP
Practice Address - State:VA
Practice Address - Zip Code:24277-2315
Practice Address - Country:US
Practice Address - Phone:276-546-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist