Provider Demographics
NPI:1033455928
Name:ANDERSON, RAY GENE (RPH)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:GENE
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 W MAGNOLIA AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:GENEVA
Mailing Address - State:AL
Mailing Address - Zip Code:36340-1213
Mailing Address - Country:US
Mailing Address - Phone:334-684-7011
Mailing Address - Fax:
Practice Address - Street 1:1541 W MAGNOLIA AVE
Practice Address - Street 2:STE 2
Practice Address - City:GENEVA
Practice Address - State:AL
Practice Address - Zip Code:36340-1213
Practice Address - Country:US
Practice Address - Phone:334-684-7011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL12219OtherALABAMA PHARMACY LICENSE NUMBER