Provider Demographics
NPI:1962696401
Name:GAY, VIRGINIA FAISON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:FAISON
Last Name:GAY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DEER HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-8954
Mailing Address - Country:US
Mailing Address - Phone:859-879-9577
Mailing Address - Fax:
Practice Address - Street 1:100 DEER HAVEN DR
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-8954
Practice Address - Country:US
Practice Address - Phone:859-879-9577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY013762183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist