Provider Demographics
NPI:1386199727
Name:INGRAM, RAELIN STORM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RAELIN
Middle Name:STORM
Last Name:INGRAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 CANTON RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-1544
Mailing Address - Country:US
Mailing Address - Phone:330-733-4237
Mailing Address - Fax:
Practice Address - Street 1:302 CANTON RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-1544
Practice Address - Country:US
Practice Address - Phone:330-733-4237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03135885183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist