Provider Demographics
NPI:1083131882
Name:RAY, CHERYLL ANGEL (RPH)
Entity Type:Individual
Prefix:
First Name:CHERYLL
Middle Name:ANGEL
Last Name:RAY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 PEYTON CIR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-8171
Mailing Address - Country:US
Mailing Address - Phone:662-234-0584
Mailing Address - Fax:
Practice Address - Street 1:101 W SWEET POTATO ST
Practice Address - Street 2:
Practice Address - City:VARDAMAN
Practice Address - State:MS
Practice Address - Zip Code:38878-9433
Practice Address - Country:US
Practice Address - Phone:833-773-1885
Practice Address - Fax:888-804-2104
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-08809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist