Provider Demographics
NPI:1073513578
Name:MASTRIANI, RAYMOND ANTHONY (RPH, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:ANTHONY
Last Name:MASTRIANI
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 HEATHER HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-2143
Mailing Address - Country:US
Mailing Address - Phone:617-571-0158
Mailing Address - Fax:508-967-7083
Practice Address - Street 1:65 HEATHER HILLS DR
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-2143
Practice Address - Country:US
Practice Address - Phone:617-571-0158
Practice Address - Fax:508-967-7083
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4555183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist