Provider Demographics
NPI:1336743624
Name:RAY, GARRY
Entity Type:Individual
Prefix:
First Name:GARRY
Middle Name:
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 1:101 CHESNUT BYP
Mailing Address - Street 2:
Mailing Address - City:CENTRE
Mailing Address - State:AL
Mailing Address - Zip Code:35960-1427
Mailing Address - Country:US
Mailing Address - Phone:256-927-2420
Mailing Address - Fax:
Practice Address - Street 1:101 CHESNUT BYP
Practice Address - Street 2:
Practice Address - City:CENTRE
Practice Address - State:AL
Practice Address - Zip Code:35960-1427
Practice Address - Country:US
Practice Address - Phone:256-927-2420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-26
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist