Provider Demographics
NPI:1780717223
Name:CHILDS, LORAY THOMAS (RPH)
Entity type:Individual
Prefix:
First Name:LORAY
Middle Name:THOMAS
Last Name:CHILDS
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:PO BOX 1544
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:GA
Mailing Address - Zip Code:31032-1544
Mailing Address - Country:US
Mailing Address - Phone:478-986-9652
Mailing Address - Fax:
Practice Address - Street 1:126 W CLINTON ST
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:GA
Practice Address - Zip Code:31032-5322
Practice Address - Country:US
Practice Address - Phone:478-986-3161
Practice Address - Fax:478-986-5056
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15827183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist