Provider Demographics
NPI:1962047845
Name:RAY, JAMES ROBERT
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:RAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2483 CLEAR BROOK CIR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-3977
Mailing Address - Country:US
Mailing Address - Phone:920-471-3823
Mailing Address - Fax:
Practice Address - Street 1:525 AIRPORT DR
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:WI
Practice Address - Zip Code:54155-9035
Practice Address - Country:US
Practice Address - Phone:920-869-4826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10971-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI337376OtherNAPB