# FREDERICK RAY PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093340820
- **Authorized official:** DR. DANIEL TAVARES PHARMD (PHARMACY MANAGER/OWNER)
- **Authorized official phone:** (860) 367-4773

## Contact information

- **Practice address:** 26 FALLS RD, MOODUS, CT 06469-1262
- **Practice address phone:** (860) 367-4773
- **Mailing address:** PO BOX 457, MOODUS, CT 06469-0457

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 03/12/2020
- **Last updated:** 03/12/2020