Provider Demographics
NPI:1295245637
Name:GRAY, ANDREW L (RPH)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:L
Last Name:GRAY
Suffix:
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 1:9881 COMMERCE ST STE A
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30747-1300
Mailing Address - Country:US
Mailing Address - Phone:706-808-1100
Mailing Address - Fax:706-808-1103
Practice Address - Street 1:9881 COMMERCE ST STE A
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30747-1300
Practice Address - Country:US
Practice Address - Phone:706-808-1100
Practice Address - Fax:706-808-1103
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019412183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist