Provider Demographics
NPI:1063853026
Name:RAY, CLARISSA (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:CLARISSA
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1735
Mailing Address - Country:US
Mailing Address - Phone:717-520-9499
Mailing Address - Fax:
Practice Address - Street 1:337 W CHOCOLATE AVE
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1674
Practice Address - Country:US
Practice Address - Phone:717-520-9499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.294024183500000X
FLPS26664183500000X
PARP437248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist