Provider Demographics
NPI:1649588237
Name:GRAY, JOHN RICHARD JR (RPH)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RICHARD
Last Name:GRAY
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3547
Mailing Address - Country:US
Mailing Address - Phone:318-429-0161
Mailing Address - Fax:318-429-0163
Practice Address - Street 1:2255 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3547
Practice Address - Country:US
Practice Address - Phone:318-429-0161
Practice Address - Fax:318-429-0163
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17020183500000X
LAPST.017020183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacist