Provider Demographics
NPI:1598113045
Name:BESECKER, RAYMOND ALAN (RPH)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:ALAN
Last Name:BESECKER
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 1:114 LT MICHAEL CLEARY DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-1649
Mailing Address - Country:US
Mailing Address - Phone:570-255-1167
Mailing Address - Fax:570-255-1169
Practice Address - Street 1:114 LT MICHAEL CLEARY DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-1649
Practice Address - Country:US
Practice Address - Phone:570-255-1167
Practice Address - Fax:570-255-1169
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040141L183500000X
PARPI006025183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist