Provider Demographics
NPI:1588385116
Name:GREY & TEAL
Entity type:Organization
Organization Name:GREY & TEAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:T
Authorized Official - Last Name:LOCKLEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-210-2030
Mailing Address - Street 1:7910 US HWY 117 S UNIT 110
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NC
Mailing Address - Zip Code:28457-7409
Mailing Address - Country:US
Mailing Address - Phone:910-210-2030
Mailing Address - Fax:910-210-2031
Practice Address - Street 1:7910 US HWY 117 S UNIT 110
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NC
Practice Address - Zip Code:28457-7409
Practice Address - Country:US
Practice Address - Phone:910-210-2030
Practice Address - Fax:910-210-2031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1033686175Medicaid