Healthcare Provider Details

I. General information

NPI: 1982972485
Provider Name (Legal Business Name): KEVIN JAMES BRAY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14H MIRIAM ST
KEY WEST FL
33040-5754
US

IV. Provider business mailing address

14H MIRIAM ST
KEY WEST FL
33040-5754
US

V. Phone/Fax

Practice location:
  • Phone: 352-246-8485
  • Fax:
Mailing address:
  • Phone: 352-246-8485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS37777
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: