1003867227 NPI number — RAY'S PHARMACY, INC.

Table of content: (NPI 1003867227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003867227 NPI number — RAY'S PHARMACY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAY'S PHARMACY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003867227
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1831 E BROAD ST
Provider Second Line Business Mailing Address:
207
Provider Business Mailing Address City Name:
MANSFIELD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76063-9170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-473-1147
Provider Business Mailing Address Fax Number:
817-473-9555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1831 E BROAD ST
Provider Second Line Business Practice Location Address:
101
Provider Business Practice Location Address City Name:
MANSFIELD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76063-9170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-473-1145
Provider Business Practice Location Address Fax Number:
817-473-6749
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAY
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
817-473-1505

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  01376 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C08409365 . This is a "MEDICARE EDI NO." identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: D08601893 . This is a "DMERC REG D EDI #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 140266 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100244580A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4511374 . This is a "NCPDP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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