Provider Demographics
NPI:1558889915
Name:RAYNERI, GENEICE
Entity Type:Individual
Prefix:
First Name:GENEICE
Middle Name:
Last Name:RAYNERI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 38TH ST
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-3510
Mailing Address - Country:US
Mailing Address - Phone:504-443-1294
Mailing Address - Fax:
Practice Address - Street 1:2124 38TH ST
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3510
Practice Address - Country:US
Practice Address - Phone:504-443-1294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST015082183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist