Jacient D. Bray, R. PH.
Individual provider Active NPI Pharmacist · Brockway, PA
NPI 1932232683 · NPPES record last updated Jul 8, 2007
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(3) exclusion effective Oct 20, 2010.
Key facts
- NPI
- 1932232683
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- RP042532L (PA)
- Practice address
- 411 Main St
Brockway, PA 15824-1324 - Phone
- (814) 265-0050
- Fax
- (814) 265-0605
- NPI assigned
- Mar 13, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP042532L | PA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hometown Drug LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP042532L | PA | Yes |
Addresses
Primary practice location
411 Main St
Brockway, PA 15824-1324
Mailing address
1170 McCain St
Brockway, PA 15824-1828
Phone (814) 265-2130
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RP042532L | Other | PA | STATE LICENSE |
Other providers in Brockway, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- OIG LEIE (HHS Office of Inspector General).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.