Provider Demographics
NPI:1851889554
Name:GRAY, JENNIFER HAMILTON
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HAMILTON
Last Name:GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 HUNTERS XING
Mailing Address - Street 2:
Mailing Address - City:ALCOA
Mailing Address - State:TN
Mailing Address - Zip Code:37701-1849
Mailing Address - Country:US
Mailing Address - Phone:865-984-2671
Mailing Address - Fax:865-984-2875
Practice Address - Street 1:1030 HUNTERS XING
Practice Address - Street 2:
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701-1849
Practice Address - Country:US
Practice Address - Phone:865-984-2671
Practice Address - Fax:865-984-2875
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12076183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist