Provider Demographics
NPI:1134335201
Name:BRAY PHARMACY INC
Entity type:Organization
Organization Name:BRAY PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:502-223-2827
Mailing Address - Street 1:662 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-2338
Mailing Address - Country:US
Mailing Address - Phone:502-223-2827
Mailing Address - Fax:502-227-2026
Practice Address - Street 1:662 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-2338
Practice Address - Country:US
Practice Address - Phone:502-223-2827
Practice Address - Fax:502-227-2026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9000882200332B00000X, 332BC3200X, 332BP3500X, 332BX2000X, 335E00000X
KY1186150001332BC3200X, 332BP3500X, 332BX2000X, 335E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY18D0968102OtherCLIA CERTIFICATION
KY9000882200Medicaid
KYP01908OtherSTORE KY LICENSE
KYMG0158OtherKY MED GAS LICENSE
KY9000882200Medicaid