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NPI Code Detail

MEDICARE: DR. TREVOR VANCE RAY PHARMD.

MEDICARE: DR. TREVOR VANCE RAY PHARMD.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist012012KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1012012OTHERKYKENTUCKY STATE LICENSE

General Provider Information

NPI Number : 1982682878
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TREVOR VANCE RAY PHARMD.
Provider Business Mailing Address
First Line : 908 WALLACE AVE
Second Line : SUITE 105
City : LEITCHFIELD
State : KY
Zip : 42754-1479
Country : US
Telephone Number : 270-259-8500
Fax Number : 270-230-8517
Provider Business Practice Location Address
First Line : 908 WALLACE AVE
Second Line : SUITE 105
City : LEITCHFIELD
State : KY
Zip : 42754-1479
Country : US
Telephone Number : 270-259-8500
Fax Number : 270-230-8517
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2006
Last Update Date : 04/25/2011

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