Individual
DANIELLE GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
810 SE WASHINGTON ST, IDABEL, OK 74745-3332
(580) 245-6169
Mailing address
810 SE WASHINGTON ST, IDABEL, OK 74745-3332
(580) 245-6169
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
17589
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17589
PHARMD
OK
Enumeration date
11/17/2020
Last updated
11/17/2020
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