Provider Demographics
NPI:1215064571
Name:GRAY COURT PHARMACY
Entity type:Organization
Organization Name:GRAY COURT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:864-876-3837
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:GRAY COURT
Mailing Address - State:SC
Mailing Address - Zip Code:29645
Mailing Address - Country:US
Mailing Address - Phone:864-876-3837
Mailing Address - Fax:864-876-1137
Practice Address - Street 1:345 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAY COURT
Practice Address - State:SC
Practice Address - Zip Code:29645
Practice Address - Country:US
Practice Address - Phone:864-876-3837
Practice Address - Fax:864-876-1137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50001172333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC711725Medicaid