Most Relevant Information
Provider Data
| NPI Number: | 1003432337 |
| Provider Name: | JACOBY GRAY PHARD |
| Entity Type: | Individual |
| Taxonomy Code: | 183500000X |
| Specialty: | Pharmacist |
| License Number: | 18283 |
Most Important Dates
| Enumeration Date: | 06/23/2020 |
| Last Updated: | 06/23/2020 |
Provider Practice Location
1605 W ELM ST
EL RENO
OK
730364261
Practice Location Phone/Fax
| Phone: | 4052624154 |
| Fax: | 4052620912 |
Provider Mailing Location
1605 W ELM ST
EL RENO
OK
730364261
Provider Mailing Phone/Fax
| Phone: | 4052624154 |
| Fax: |