Provider Demographics
NPI:1760137236
Name:BRAY, DANIELLA ROSE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLA
Middle Name:ROSE
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 1:157 MARK TREE RD
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-2239
Mailing Address - Country:US
Mailing Address - Phone:516-983-4928
Mailing Address - Fax:
Practice Address - Street 1:3000 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1072
Practice Address - Country:US
Practice Address - Phone:631-366-0934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068871183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist