Provider Demographics
NPI:1801004924
Name:ALLY, RAY R (RPH)
Entity type:Individual
Prefix:MR
First Name:RAY
Middle Name:R
Last Name:ALLY
Suffix:
Gender:M
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 1441
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95381-1441
Mailing Address - Country:US
Mailing Address - Phone:240-313-5937
Mailing Address - Fax:
Practice Address - Street 1:4091 BERKELEY AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-7415
Practice Address - Country:US
Practice Address - Phone:240-313-5937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist