Provider Demographics
NPI:1477179885
Name:RAI, GERALD JR (PHARMD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:RAI
Suffix:JR
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 1:26140 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-4100
Mailing Address - Country:US
Mailing Address - Phone:909-647-5664
Mailing Address - Fax:
Practice Address - Street 1:26140 WINDSOR DR
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-4100
Practice Address - Country:US
Practice Address - Phone:909-647-5664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist