Organization
GRAY PHARM INC
Active
Other names
The Pharmacy Shoppe
Organization subpart
No
Provider details
NPI number
Authorized official
BARTHOLEMEW HARDWELL (OWNER)
(318) 323-2883
Entity
Organization
Contact information
Practice address
1510 S 2ND ST, MONROE, LA 71202-2742
(318) 323-2883
(318) 323-8732
Mailing address
1510 S 2ND ST, MONROE, LA 71202-2742
(318) 323-2883
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY.007717-IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2205102
—
LA
Enumeration date
06/08/2016
Last updated
05/31/2018
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