Provider Demographics
NPI:1225584022
Name:RAY, JARRELL ALAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:JARRELL
Middle Name:ALAN
Last Name:RAY
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 1:2056 RAY RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:39813-1420
Mailing Address - Country:US
Mailing Address - Phone:229-894-2156
Mailing Address - Fax:
Practice Address - Street 1:19427 HARTFORD ST
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:GA
Practice Address - Zip Code:39846
Practice Address - Country:US
Practice Address - Phone:229-835-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014712183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist