Provider Demographics
NPI:1003410051
Name:MARCHIONDA, RAYMOND JR (PHARMD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:MARCHIONDA
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 E 66TH ST APT 307
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-0219
Mailing Address - Country:US
Mailing Address - Phone:586-872-8406
Mailing Address - Fax:
Practice Address - Street 1:9550 ALLISONVILLE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-1201
Practice Address - Country:US
Practice Address - Phone:317-842-4458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26028848A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist