Provider Demographics
NPI:1417263906
Name:RAINGE, MARCUS T (MARCUS RAINGE)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:T
Last Name:RAINGE
Suffix:
Gender:M
Credentials:MARCUS RAINGE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 E THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7710
Mailing Address - Country:US
Mailing Address - Phone:602-933-2048
Mailing Address - Fax:602-933-2057
Practice Address - Street 1:1919 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7710
Practice Address - Country:US
Practice Address - Phone:602-933-2048
Practice Address - Fax:602-933-2057
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS017220183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist