Provider Demographics
NPI:1598700270
Name:RAINES, GARY ALLAN (R PHARM)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:ALLAN
Last Name:RAINES
Suffix:
Gender:M
Credentials:R PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2582 PARKVIEW CT
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-5784
Mailing Address - Country:US
Mailing Address - Phone:651-653-7715
Mailing Address - Fax:651-488-7517
Practice Address - Street 1:1685 RICE ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-6802
Practice Address - Country:US
Practice Address - Phone:651-488-0251
Practice Address - Fax:651-488-7517
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN111319-0183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist