| NPI | 1861599243 |
|---|---|
| Former Name | TERESA LYNN GRAY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NE 12464) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 14371-040) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2007-07-08 |