Provider Demographics
NPI:1881979656
Name:RAY, ROBERT ALEXANDER (RPH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALEXANDER
Last Name:RAY
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 1:9427 S SUNCOAST BLVD
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446-5033
Mailing Address - Country:US
Mailing Address - Phone:352-382-0520
Mailing Address - Fax:352-382-1488
Practice Address - Street 1:9427 S SUNCOAST BLVD
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34446-5033
Practice Address - Country:US
Practice Address - Phone:352-382-0520
Practice Address - Fax:352-382-1488
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist