Provider Demographics
NPI:1003070236
Name:RAY, JAY RICHARD (RPH)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:RICHARD
Last Name:RAY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:RICHIE
Other - Middle Name:
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:12820 HIGHWAY 105 W
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-1574
Mailing Address - Country:US
Mailing Address - Phone:936-588-6337
Mailing Address - Fax:936-588-2232
Practice Address - Street 1:12820 HIGHWAY 105 W
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-1574
Practice Address - Country:US
Practice Address - Phone:936-588-6337
Practice Address - Fax:936-588-2232
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist