Jacoby Gray, PHARD

Primary specialty

PharmacistTaxonomy code 183500000X

License

18283 Issued in OK

Practice address

1605 W Elm St
El Reno, OK 73036-4261

Phone

(405) 262-4154

Fax

(405) 262-0912

NPI assigned

Jun 23, 2020

Last updated

Jun 23, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Telos Compounding Solutions LLC

  • Community/Retail Pharmacy
  • Yukon, OK
  • NPI 1073484523
  NPD Authorized official
• Telos Wellness and Vitality LLC

  • Clinic/Center
  • Yukon, OK
  • NPI 1073463733
  NPD
• Canadian Valley RX, Inc.

  dba Canadian Valley Pharmacy

  • Community/Retail Pharmacy
  • El Reno, OK
  • NPI 1265442164
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1592870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592870400000",
    "number": "1003432337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1605 W ELM ST",
            "city": "EL RENO",
            "state": "OK",
            "postal_code": "730364261",
            "telephone_number": "405-262-4154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 W ELM ST",
            "city": "EL RENO",
            "state": "OK",
            "postal_code": "730364261",
            "telephone_number": "405-262-4154",
            "fax_number": "405-262-0912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "JACOBY",
        "credential": "PHARD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-23",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OK",
            "license": "18283",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dakota Goodwin
• Lakendra Janell Gould
• Grand Dental El Reno, PLLC
• Candice Grandstaff
• Valorie Jean Graves, PA
• Angela Green
• Lee Ann Green
• Kathy Ann Gunter, P.A.-C.
• Madison Jewel Haasl, M.ED, LPC-C
• Hac, Inc. (United Pharmacy #401)

• Pharmacist in El Reno, OK
• Providers in El Reno, OK by specialty
• Pharmacist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.