Provider Demographics
NPI:1881697480
Name:GRAY, STEVE (PHARM D, RPH)
Entity type:Individual
Prefix:DR
First Name:STEVE
Middle Name:
Last Name:GRAY
Suffix:
Gender:M
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-2616
Mailing Address - Country:US
Mailing Address - Phone:605-224-0789
Mailing Address - Fax:
Practice Address - Street 1:601 GALL ST
Practice Address - Street 2:
Practice Address - City:LOWER BRULE
Practice Address - State:SD
Practice Address - Zip Code:57548
Practice Address - Country:US
Practice Address - Phone:605-473-8226
Practice Address - Fax:605-473-0708
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR-5129183500000X
MI5302029104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDR-5129OtherPHARMACIST LICENSE
MI5302029104OtherPHARMACIST LICENSE