Robert W Gray
Organization Active NPI Pharmacy · Lynchburg, TN
NPI 1053455758 · NPPES record last updated Jun 16, 2008
Key facts
- NPI
- 1053455758
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- 0000000633 (TN)
- Legal business name
- ROBERT W GRAY
- Practice address
- 47 Mechanic St
Eastside Public Square
Lynchburg, TN 37352 - Phone
- (931) 759-7329
- Fax
- (931) 759-4604
- NPI assigned
- Feb 16, 2007
- Organization subpart
- No
Authorized official
- Name
- Robert Gray, DPH
- Title
- Owner
- Phone
- (931) 759-7329
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 0000000633 | TN | Yes |
| Community/Retail Pharmacy | 3336C0003X | |||
| Compounding Pharmacy | 3336C0004X |
Addresses
Primary practice location
47 Mechanic St
Eastside Public Square
Lynchburg, TN 37352
Mailing address
PO Box 174
Lynchburg, TN 37352-0174
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4424595 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 4424595 | Medicaid | TN | |
| 4424595 | Other | OTHER ID NUMBER |
Other names
- LYNCHBURG DRUG STORE
Other providers in Lynchburg, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 16, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.