Provider Demographics
NPI:1467860056
Name:BLOOM, RAYMOND VINCENT (PHARMD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:VINCENT
Last Name:BLOOM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:674 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NORRIDGEWOCK
Mailing Address - State:ME
Mailing Address - Zip Code:04957-3423
Mailing Address - Country:US
Mailing Address - Phone:207-474-8928
Mailing Address - Fax:
Practice Address - Street 1:225 MADISON AVE
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-2054
Practice Address - Country:US
Practice Address - Phone:207-474-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-26
Last Update Date:2014-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR27843183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist