Provider Demographics
NPI:1497037535
Name:GRAY-WILSON, LENI LAVERN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LENI
Middle Name:LAVERN
Last Name:GRAY-WILSON
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 1:5308 HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23607-2020
Mailing Address - Country:US
Mailing Address - Phone:757-247-1369
Mailing Address - Fax:757-247-1369
Practice Address - Street 1:919 W MERCURY BLVD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-4322
Practice Address - Country:US
Practice Address - Phone:757-827-2995
Practice Address - Fax:757-827-2982
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02020072811835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist