Provider Demographics
NPI:1972156750
Name:GRAY, HAILEY SUZANNE (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:SUZANNE
Last Name:GRAY
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 SUSIE ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:TX
Mailing Address - Zip Code:75758-2331
Mailing Address - Country:US
Mailing Address - Phone:903-805-1891
Mailing Address - Fax:
Practice Address - Street 1:1620 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4260
Practice Address - Country:US
Practice Address - Phone:903-533-0367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist