Provider Demographics
NPI:1831192517
Name:MADDOX, RAY REGINALD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RAY
Middle Name:REGINALD
Last Name:MADDOX
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15 MONTAUK DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-4919
Mailing Address - Country:US
Mailing Address - Phone:912-727-2843
Mailing Address - Fax:
Practice Address - Street 1:5353 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6015
Practice Address - Country:US
Practice Address - Phone:912-819-6398
Practice Address - Fax:912-691-9070
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106771835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy