Healthcare Provider Details

I. General information

NPI: 1265843445
Provider Name (Legal Business Name): WRAY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 05/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 E 7TH ST
BROOKLYN NY
11218-4801
US

IV. Provider business mailing address

533 E 7TH ST
BROOKLYN NY
11218-4801
US

V. Phone/Fax

Practice location:
  • Phone: 718-282-9200
  • Fax: 718-282-7930
Mailing address:
  • Phone: 718-282-9200
  • Fax: 718-282-7930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number032662
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JELANI WRAY
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 718-612-1232