Provider Demographics
NPI:1609177872
Name:WASSON, RAYMOND RICHARD (RPH)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:RICHARD
Last Name:WASSON
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:PO BOX 1056
Mailing Address - Street 2:
Mailing Address - City:KINGS BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:96143-1056
Mailing Address - Country:US
Mailing Address - Phone:530-546-0186
Mailing Address - Fax:530-546-0277
Practice Address - Street 1:7815 NORTH LAKE BLVD.
Practice Address - Street 2:
Practice Address - City:KINGS BEACH
Practice Address - State:CA
Practice Address - Zip Code:96143
Practice Address - Country:US
Practice Address - Phone:530-546-0186
Practice Address - Fax:530-546-0277
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 25826183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist