Provider Demographics
NPI:1265508378
Name:RAYS HEALTH MART PHARMACY
Entity Type:Organization
Organization Name:RAYS HEALTH MART PHARMACY
Other - Org Name:RAYS HEALTH MART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:540-887-2228
Mailing Address - Street 1:1011 N AUGUSTA ST
Mailing Address - Street 2:STE C
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-3298
Mailing Address - Country:US
Mailing Address - Phone:540-887-2228
Mailing Address - Fax:540-887-1252
Practice Address - Street 1:1011 N AUGUSTA ST
Practice Address - Street 2:STE C
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-3298
Practice Address - Country:US
Practice Address - Phone:540-887-2228
Practice Address - Fax:540-887-1252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010041183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010361095Medicaid
2105997OtherPK
2105997OtherPK