Provider Demographics
NPI:1639917594
Name:ROUNTREE, GRAYSON (PHARMD)
Entity type:Individual
Prefix:
First Name:GRAYSON
Middle Name:
Last Name:ROUNTREE
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 1:2506 WILD TIMBER WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-2421
Mailing Address - Country:US
Mailing Address - Phone:423-244-1228
Mailing Address - Fax:
Practice Address - Street 1:9225 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-2303
Practice Address - Country:US
Practice Address - Phone:865-985-7970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist