Provider Demographics
NPI:1942502018
Name:RAY, KIMBERLY LEE (RPH)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LEE
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 1:10820 N 84TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6552
Mailing Address - Country:US
Mailing Address - Phone:480-286-3621
Mailing Address - Fax:
Practice Address - Street 1:13733 N FOUNTAIN HILLS BLVD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-3730
Practice Address - Country:US
Practice Address - Phone:480-837-1690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist