Provider Demographics
NPI:1619953528
Name:HOWARD, EDDIE RAY JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:EDDIE
Middle Name:RAY
Last Name:HOWARD
Suffix:JR
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 317
Mailing Address - Street 2:
Mailing Address - City:SOULSBYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95372-0317
Mailing Address - Country:US
Mailing Address - Phone:209-532-4299
Mailing Address - Fax:
Practice Address - Street 1:1045 MONO WAY
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5282
Practice Address - Country:US
Practice Address - Phone:209-536-1118
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist