Provider Demographics
NPI:1417297474
Name:LEVAY, MARK RAYMOND
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:RAYMOND
Last Name:LEVAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-1347
Mailing Address - Country:US
Mailing Address - Phone:254-699-8810
Mailing Address - Fax:254-699-9206
Practice Address - Street 1:601 INDIAN TRL
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-1347
Practice Address - Country:US
Practice Address - Phone:254-699-8810
Practice Address - Fax:254-699-9206
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35770183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist