Active NPI
Phyllis Myra Grayson, R.PH.
- Pharmacist
- Stone Mountain, GA
National Provider Identifier
1992081574
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH015607
- Practice address
- 790 Masters Dr
Stone Mountain, GA 30087-5286 - Phone
- (770) 497-4130
- NPI assigned
- Oct 27, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH015607 | GA | Primary |
Addresses
Primary practice location
790 Masters Dr
Stone Mountain, GA 30087-5286
Mailing address
790 Masters Dr
Stone Mountain, GA 30087-5286
Phone (770) 497-4130
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH015607 | GA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1319673600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319673600000",
"number": "1992081574",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "790 MASTERS DR",
"city": "STONE MOUNTAIN",
"state": "GA",
"postal_code": "300875286",
"telephone_number": "770-497-4130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "790 MASTERS DR",
"city": "STONE MOUNTAIN",
"state": "GA",
"postal_code": "300875286",
"telephone_number": "770-497-4130"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAYSON",
"first_name": "PHYLLIS",
"middle_name": "MYRA",
"name_prefix": "Mrs.",
"credential": "R.PH.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-10-27",
"last_updated": "2011-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH015607",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stone Mountain, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.