Provider Demographics
NPI:1013287549
Name:GRAY, MATTHEW JARED (PHARMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JARED
Last Name:GRAY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 E UNIVERSITY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32641-5614
Mailing Address - Country:US
Mailing Address - Phone:352-327-4294
Mailing Address - Fax:352-327-4295
Practice Address - Street 1:1120 E UNIVERSITY AVE STE 200
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32641-5614
Practice Address - Country:US
Practice Address - Phone:352-327-4294
Practice Address - Fax:352-327-4295
Is Sole Proprietor?:No
Enumeration Date:2011-12-30
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47323183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist