Provider Demographics
NPI:1629363502
Name:GRAY, ANGELA DENEAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:DENEAN
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 1:2460 PRINCE WILLIAM PKWY
Mailing Address - Street 2:T-0759
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4148
Mailing Address - Country:US
Mailing Address - Phone:703-490-4415
Mailing Address - Fax:703-490-4415
Practice Address - Street 1:2460 PRINCE WILLIAM PKWY
Practice Address - Street 2:T-0759
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4148
Practice Address - Country:US
Practice Address - Phone:703-490-4415
Practice Address - Fax:703-490-4415
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-18
Last Update Date:2011-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207035183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist