Provider Demographics
NPI:1003192022
Name:RAUTON, TONYA BERNICE
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:BERNICE
Last Name:RAUTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1284 KNOX AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-4055
Mailing Address - Country:US
Mailing Address - Phone:803-442-4510
Mailing Address - Fax:803-442-4515
Practice Address - Street 1:1284 KNOX AVE
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-4055
Practice Address - Country:US
Practice Address - Phone:803-442-4510
Practice Address - Fax:803-442-4515
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist