Provider Demographics
NPI:1477890234
Name:MACIEJEWSKI, RAY W (PHARM D)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:W
Last Name:MACIEJEWSKI
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 WINTER SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9342
Mailing Address - Country:US
Mailing Address - Phone:407-366-9810
Mailing Address - Fax:407-366-5960
Practice Address - Street 1:2100 WINTER SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9342
Practice Address - Country:US
Practice Address - Phone:407-366-9810
Practice Address - Fax:407-366-5960
Is Sole Proprietor?:No
Enumeration Date:2013-01-12
Last Update Date:2013-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist