Provider Demographics
NPI:1447841028
Name:RAY, CARSON (DOCTOR OF PHARMACY)
Entity type:Individual
Prefix:MR
First Name:CARSON
Middle Name:
Last Name:RAY
Suffix:
Gender:M
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 MAXWELL ST SE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:39813-8712
Mailing Address - Country:US
Mailing Address - Phone:229-725-4212
Mailing Address - Fax:229-725-5242
Practice Address - Street 1:84 MAXWELL ST SE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:GA
Practice Address - Zip Code:39813-8712
Practice Address - Country:US
Practice Address - Phone:229-725-4212
Practice Address - Fax:229-725-5242
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH030642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist