Provider Demographics
NPI:1184856106
Name:BRAY, MICHAEL ROE SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ROE
Last Name:BRAY
Suffix:SR
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 1:521 MARTLING RD
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35951-7211
Mailing Address - Country:US
Mailing Address - Phone:256-878-4624
Mailing Address - Fax:
Practice Address - Street 1:521 MARTLING RD
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35951-7211
Practice Address - Country:US
Practice Address - Phone:256-878-4624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9366183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist