Provider Demographics
NPI:1609194224
Name:WILLS, JOHN RAY (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RAY
Last Name:WILLS
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 1:909 MIRAMAR PL
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-2127
Mailing Address - Country:US
Mailing Address - Phone:361-993-8515
Mailing Address - Fax:361-980-1446
Practice Address - Street 1:4320 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-2412
Practice Address - Country:US
Practice Address - Phone:361-993-8515
Practice Address - Fax:361-980-1446
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist