Provider Demographics
NPI:1538362439
Name:RAY, DAVID CYRUS (RPH)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CYRUS
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 1:1407 ROCKLEDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3718
Mailing Address - Country:US
Mailing Address - Phone:321-639-3624
Mailing Address - Fax:321-639-3624
Practice Address - Street 1:2020 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-2335
Practice Address - Country:US
Practice Address - Phone:321-952-6020
Practice Address - Fax:321-952-6037
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS10758183500000X
FLPU1409183500000X
TN3256183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPU 1409OtherCONSULTANCE PHARM LICENSE
TN3256OtherTENNESSEE PHARM LICENSE
FLPS10758OtherPRIMARY PHARM LICENSE