Provider Demographics
NPI:1497355291
Name:RAY, JENNIFER ANN (RPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:RAY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 CHEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-7402
Mailing Address - Country:US
Mailing Address - Phone:501-551-6770
Mailing Address - Fax:
Practice Address - Street 1:8801 HIGHWAY 107
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-2929
Practice Address - Country:US
Practice Address - Phone:501-833-3116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD10410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist