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General NPI Number Information
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NPI Number | 1396881595
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Entity Type | Organization
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Legal Business Name | RICKY DANE RAY
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 06/11/2012
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Provider Practice Location Address
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Address Line | 801 ROAD TO SIX FLAGS W SUITE 122
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City | ARLINGTON
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State | TX
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Zip | 76012-2616
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Country | US
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Telephone | 817-277-7231
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Fax | 817-277-7534
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Provider Business Mailing Address
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Address Line | 801 ROAD TO SIX FLAGS W SUITE 122
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City | ARLINGTON
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State | TX
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Zip | 76012-2616
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Country | US
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Telephone | 817-277-7231
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Fax | 817-277-7534
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MR. RICKY DANE RAY
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Credential |
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Telephone | 817-277-7231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 26087
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License Number State | TX
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