Organization
ROBERT W GRAY
Active
Other names
LYNCHBURG DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT GRAY DPH (OWNER)
(931) 759-7329
Entity
Organization
Contact information
Practice address
47 MECHANIC ST, EASTSIDE PUBLIC SQUARE, LYNCHBURG, TN 37352
(931) 759-7329
(931) 759-4604
Mailing address
PO BOX 174, LYNCHBURG, TN 37352-0174
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
0000000633
TN
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4424595
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
4424595
—
TN
Enumeration date
02/16/2007
Last updated
06/16/2008
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