Individual
MR. JACIENT D. BRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R. PH.
Contact information
Practice address
411 MAIN ST, BROCKWAY, PA 15824-1324
(814) 265-0050
(814) 265-0605
Mailing address
1170 MCCAIN ST, BROCKWAY, PA 15824-1828
(814) 265-2130
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP042532L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RP042532L
STATE LICENSE
PA
Enumeration date
03/13/2007
Last updated
07/08/2007
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