Individual
JACOBY GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARD
Contact information
Practice address
1605 W ELM ST, EL RENO, OK 73036-4261
(405) 262-4154
(405) 262-0912
Mailing address
1605 W ELM ST, EL RENO, OK 73036-4261
(405) 262-4154
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
18283
OK
Other
Enumeration date
06/23/2020
Last updated
06/23/2020
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