Provider Demographics
NPI:1003999871
Name:ANDERSON, RAYMOND (RPH)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:ANDERSON
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 1:380 N BROADWAY
Mailing Address - Street 2:APT A-3
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-2059
Mailing Address - Country:US
Mailing Address - Phone:914-965-9015
Mailing Address - Fax:914-376-5113
Practice Address - Street 1:130 WEST KINGSBRIDGE ROAD 119
Practice Address - Street 2:JAMES J. PETERS VA MEDICAL CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468
Practice Address - Country:US
Practice Address - Phone:718-584-9000
Practice Address - Fax:718-741-4406
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30022183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist