Provider Demographics
NPI:1114249497
Name:DRAGANCHUK, RAYMOND (RPH)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:DRAGANCHUK
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 1:12412 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-1950
Mailing Address - Country:US
Mailing Address - Phone:727-863-5608
Mailing Address - Fax:727-819-8918
Practice Address - Street 1:12412 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-1950
Practice Address - Country:US
Practice Address - Phone:727-863-5608
Practice Address - Fax:727-819-8918
Is Sole Proprietor?:No
Enumeration Date:2010-02-27
Last Update Date:2010-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 18286183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS 18286OtherSTATE PHARMACY LICENSE