Elizabeth Edge Gray
Individual provider Active NPI Pharmacist · Cochran, GA
NPI 1598036634 · NPPES record last updated Jan 20, 2012
Key facts
- NPI
- 1598036634
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- RPH014912 (GA)
- Practice address
- 102 S 2ND St
Cochran, GA 31014-6805 - Phone
- (478) 934-3868
- Fax
- (478) 934-3874
- NPI assigned
- Jan 20, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH014912 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH014912 | GA | Yes |
Addresses
Primary practice location
102 S 2ND St
Cochran, GA 31014-6805
Mailing address
102 S 2ND St
Cochran, GA 31014-6805
Phone (478) 934-3868
Other providers in Cochran, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 20, 2012. 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.