Provider Demographics
NPI:1184229122
Name:RAYMOND, MICHAEL (R PH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:RAYMOND
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 GREENBROOK CT
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:PA
Mailing Address - Zip Code:18938-1074
Mailing Address - Country:US
Mailing Address - Phone:215-518-0647
Mailing Address - Fax:
Practice Address - Street 1:105 GREENBROOK CT
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:PA
Practice Address - Zip Code:18938-1074
Practice Address - Country:US
Practice Address - Phone:215-518-0647
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
PARP034241L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist