Provider Demographics
NPI:1568942159
Name:GRAY, KHARMEN PATRICE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KHARMEN
Middle Name:PATRICE
Last Name:GRAY
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 1:1119 IVY CLUB LN UNIT 1021
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4527
Mailing Address - Country:US
Mailing Address - Phone:901-830-7846
Mailing Address - Fax:
Practice Address - Street 1:7041 MARTIN LUTHER KING JR HWY
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-4016
Practice Address - Country:US
Practice Address - Phone:301-386-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist