Provider Demographics
NPI:1770720666
Name:GRAY, ANDREW KARL (PHARMD,, DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:KARL
Last Name:GRAY
Suffix:
Gender:M
Credentials:PHARMD,, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 ARMAND DR APT 303
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-8961
Mailing Address - Country:US
Mailing Address - Phone:202-390-3818
Mailing Address - Fax:
Practice Address - Street 1:1365 ARMAND DR APT 303
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-8961
Practice Address - Country:US
Practice Address - Phone:202-390-3818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14333122300000X
MD15836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No183500000XPharmacy Service ProvidersPharmacist