Provider Demographics
NPI:1710260062
Name:BRAY, YISA (PHARMD)
Entity Type:Individual
Prefix:
First Name:YISA
Middle Name:
Last Name:BRAY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 EVANS RD
Mailing Address - Street 2:125C
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-5861
Mailing Address - Country:US
Mailing Address - Phone:404-663-8431
Mailing Address - Fax:
Practice Address - Street 1:2990 FIVE FORKS TRICKUM RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-5872
Practice Address - Country:US
Practice Address - Phone:770-978-6475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026163183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist