Provider Demographics
NPI:1427332360
Name:WRAY, HOWARD LAWRENCE
Entity type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:LAWRENCE
Last Name:WRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:HOWARD
Other - Middle Name:L
Other - Last Name:WRAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:1423 DOROTHY AVE
Mailing Address - Street 2:P.O. BOX 1834
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-5613
Mailing Address - Country:US
Mailing Address - Phone:863-422-5335
Mailing Address - Fax:
Practice Address - Street 1:40079 HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-7800
Practice Address - Country:US
Practice Address - Phone:863-547-3903
Practice Address - Fax:863-421-0609
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS11439183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist