Provider Demographics
NPI:1003867227
Name:RAY'S PHARMACY, INC.
Entity Type:Organization
Organization Name:RAY'S PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:817-473-1505
Mailing Address - Street 1:1831 E BROAD ST
Mailing Address - Street 2:207
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-9170
Mailing Address - Country:US
Mailing Address - Phone:817-473-1147
Mailing Address - Fax:817-473-9555
Practice Address - Street 1:1831 E BROAD ST
Practice Address - Street 2:101
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-9170
Practice Address - Country:US
Practice Address - Phone:817-473-1145
Practice Address - Fax:817-473-6749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX013763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC08409365OtherMEDICARE EDI NO.
TXD08601893OtherDMERC REG D EDI #
TX140266Medicaid
OK100244580AMedicaid
TX4511374OtherNCPDP
TX0630960001Medicare ID - Type Unspecified