Provider Demographics
NPI:1275954026
Name:PRICE, RAY GORDON (PD)
Entity Type:Individual
Prefix:MR
First Name:RAY
Middle Name:GORDON
Last Name:PRICE
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17718 BLUFFVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-9293
Mailing Address - Country:US
Mailing Address - Phone:479-751-0875
Mailing Address - Fax:
Practice Address - Street 1:2004 S PLEASANT ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-6204
Practice Address - Country:US
Practice Address - Phone:479-756-0860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-20
Last Update Date:2015-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR05988183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist