Provider Demographics
NPI:1477688091
Name:HYNDS, RAYMOND RUSSELL JR
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:RUSSELL
Last Name:HYNDS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 CEDAR LN NW
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-2104
Mailing Address - Country:US
Mailing Address - Phone:812-347-3188
Mailing Address - Fax:812-347-3078
Practice Address - Street 1:1673 HIGHWAY 64 NE
Practice Address - Street 2:
Practice Address - City:NEW SALISBURY
Practice Address - State:IN
Practice Address - Zip Code:47161-8439
Practice Address - Country:US
Practice Address - Phone:812-347-3188
Practice Address - Fax:812-347-3078
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2008-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26012604A183500000X
KY012081183500000X
IL051.028541183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist