Provider Demographics
NPI:1982209318
Name:GRAY, CHASTINEY DANIELLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHASTINEY
Middle Name:DANIELLE
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 1:615 S COCKRELL HILL RD
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-2627
Mailing Address - Country:US
Mailing Address - Phone:972-298-0539
Mailing Address - Fax:
Practice Address - Street 1:615 S COCKRELL HILL RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-2627
Practice Address - Country:US
Practice Address - Phone:972-298-0539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist