Provider Demographics
NPI:1073611299
Name:SENKBEIL, RAY BRADFORD (RPH)
Entity Type:Individual
Prefix:MR
First Name:RAY
Middle Name:BRADFORD
Last Name:SENKBEIL
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 1:620 E FRANKLIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SYLVESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31791-1708
Mailing Address - Country:US
Mailing Address - Phone:229-777-0777
Mailing Address - Fax:229-777-0025
Practice Address - Street 1:620 E FRANKLIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:SYLVESTER
Practice Address - State:GA
Practice Address - Zip Code:31791-1708
Practice Address - Country:US
Practice Address - Phone:229-777-0777
Practice Address - Fax:229-777-0025
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE007898183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00672482BMedicaid
GA00672482AMedicaid
GABM4557748OtherDEA
GABM4557748OtherDEA