Individual
WAYNE GRAVITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
RT 550 MILLARD ALLEN DR, LACKEY, KY 41643
(606) 358-2661
(606) 358-9215
Mailing address
PO BOX 159, LACKEY, KY 41643-0159
(606) 358-2661
(606) 358-9215
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
007828
KY
Other
Enumeration date
03/12/2008
Last updated
03/12/2008
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