Provider Demographics
NPI:1942226568
Name:GRAY PHARMACY
Entity Type:Organization
Organization Name:GRAY PHARMACY
Other - Org Name:GRAY RESPIRATORY AND HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-477-2800
Mailing Address - Street 1:P.O. BOX 8012
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-0012
Mailing Address - Country:US
Mailing Address - Phone:423-477-2800
Mailing Address - Fax:423-477-2804
Practice Address - Street 1:208 SUNCREST ST
Practice Address - Street 2:SUITE 4
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615-3494
Practice Address - Country:US
Practice Address - Phone:423-477-2800
Practice Address - Fax:423-477-2804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000860332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0149630001OtherMEDICARE ID
VA010228115Medicaid
TN0149630001Medicaid
TN0149630001OtherMEDICARE ID