Individual
DANIELLE ALICIA GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1130 NW 22ND AVE SUITE 105, PORTLAND, OR 97210
(503) 413-8122
(503) 413-8453
Mailing address
1130 NW 22ND AVE SUITE 105, PORTLAND, OR 97210
(503) 413-8122
(503) 413-8453
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0012746
OR
Other
Enumeration date
10/03/2011
Last updated
10/03/2011
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