Provider Demographics
NPI:1700504602
Name:RAY, KRISTINE GABRIELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:GABRIELLE
Last Name:RAY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8325 BAYMEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7434
Mailing Address - Country:US
Mailing Address - Phone:904-733-6254
Mailing Address - Fax:
Practice Address - Street 1:8325 BAYMEADOWS RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7434
Practice Address - Country:US
Practice Address - Phone:904-733-6456
Practice Address - Fax:904-448-5314
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist