Provider Demographics
NPI:1790029965
Name:GRAY, NEVADA ELIZABETH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NEVADA
Middle Name:ELIZABETH
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 1:65 E WASHINGTON ST APT 3101
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-2351
Mailing Address - Country:US
Mailing Address - Phone:508-243-6115
Mailing Address - Fax:
Practice Address - Street 1:91 TAUNTON ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:MA
Practice Address - Zip Code:02762-1207
Practice Address - Country:US
Practice Address - Phone:508-643-5008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist