Provider Demographics
NPI:1386138840
Name:RAY, KATHLEEN MILLS (RPH)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MILLS
Last Name:RAY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30351 OVERSEAS HWY
Mailing Address - Street 2:
Mailing Address - City:BIG PINE KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33043-3413
Mailing Address - Country:US
Mailing Address - Phone:305-872-1371
Mailing Address - Fax:
Practice Address - Street 1:30351 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:BIG PINE KEY
Practice Address - State:FL
Practice Address - Zip Code:33043-3413
Practice Address - Country:US
Practice Address - Phone:305-872-1371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS16922183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS16922OtherFL PHARMACIST LICENSE