Provider Demographics
NPI:1003418187
Name:ALEDO, RAUL (RPH)
Entity Type:Individual
Prefix:MR
First Name:RAUL
Middle Name:
Last Name:ALEDO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 RACCOON RUN
Mailing Address - Street 2:
Mailing Address - City:EFFORT
Mailing Address - State:PA
Mailing Address - Zip Code:18330-7987
Mailing Address - Country:US
Mailing Address - Phone:646-265-9076
Mailing Address - Fax:
Practice Address - Street 1:355 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-2814
Practice Address - Country:US
Practice Address - Phone:570-424-8612
Practice Address - Fax:570-424-8706
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043746183500000X
PARP438957183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist