Provider Demographics
NPI:1932613510
Name:RAY, KEELY MARISSA (PHARMD)
Entity Type:Individual
Prefix:
First Name:KEELY
Middle Name:MARISSA
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 1:243 WALKING HORSE TRL
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-6040
Mailing Address - Country:US
Mailing Address - Phone:704-401-4021
Mailing Address - Fax:
Practice Address - Street 1:243 WALKING HORSE TRL
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-6040
Practice Address - Country:US
Practice Address - Phone:704-401-4021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-19
Last Update Date:2017-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12473183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No183500000XPharmacy Service ProvidersPharmacist