Provider Demographics
NPI:1922156033
Name:GRAY, SANDRA L (PHARMACIST)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:L
Last Name:GRAY
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5880 S JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-8313
Mailing Address - Country:US
Mailing Address - Phone:517-414-6695
Mailing Address - Fax:
Practice Address - Street 1:5880 S JACKSON RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-8313
Practice Address - Country:US
Practice Address - Phone:517-414-6695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030049174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist