Provider Demographics
NPI:1275758633
Name:RAY, ANTHONY B (RPH)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:B
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:PO BOX 985
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:SC
Mailing Address - Zip Code:29160-0985
Mailing Address - Country:US
Mailing Address - Phone:803-568-3251
Mailing Address - Fax:803-568-7590
Practice Address - Street 1:290 WEST THIRD STREET
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:SC
Practice Address - Zip Code:29160-0985
Practice Address - Country:US
Practice Address - Phone:803-568-3251
Practice Address - Fax:803-568-7590
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC009213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist