Provider Demographics
NPI:1760981641
Name:RAY, DANIEL JAMES
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAMES
Last Name:RAY
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 1:22950 FOREST RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-4327
Mailing Address - Country:US
Mailing Address - Phone:636-248-2062
Mailing Address - Fax:
Practice Address - Street 1:20311 GRANDE OAK SHOPPES BLVD
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-7662
Practice Address - Country:US
Practice Address - Phone:239-495-9013
Practice Address - Fax:239-495-7638
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS17233183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist