Provider Demographics
NPI:1275123630
Name:RAY, MARISA LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARISA
Middle Name:LYNN
Last Name:RAY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29480 KELLOGG AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-3701
Mailing Address - Country:US
Mailing Address - Phone:816-800-2856
Mailing Address - Fax:
Practice Address - Street 1:500 N BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-3214
Practice Address - Country:US
Practice Address - Phone:816-800-2856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016026625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist