Provider Demographics
NPI:1487827689
Name:PERSHING, RAYMOND J (RPH)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:J
Last Name:PERSHING
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 GROSS POINT RD
Mailing Address - Street 2:# 303
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4977
Mailing Address - Country:US
Mailing Address - Phone:847-733-0445
Mailing Address - Fax:
Practice Address - Street 1:2907 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-2937
Practice Address - Country:US
Practice Address - Phone:773-274-3593
Practice Address - Fax:773-274-3741
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.026068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist