Provider Demographics
NPI:1568617199
Name:EMOND, RAYMOND J (RPH)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:J
Last Name:EMOND
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 1:215 S RIDGE ST
Mailing Address - Street 2:BOX 505
Mailing Address - City:PORT SANILAC
Mailing Address - State:MI
Mailing Address - Zip Code:48469-9704
Mailing Address - Country:US
Mailing Address - Phone:810-622-8320
Mailing Address - Fax:810-679-4154
Practice Address - Street 1:57 N HOWARD AVE
Practice Address - Street 2:
Practice Address - City:CROSWELL
Practice Address - State:MI
Practice Address - Zip Code:48422-1222
Practice Address - Country:US
Practice Address - Phone:810-679-3900
Practice Address - Fax:810-679-2364
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist