Provider Demographics
NPI:1639606304
Name:RAGLESS, KEVIN D (PHARMD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:RAGLESS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E MARY ST
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820-1829
Mailing Address - Country:US
Mailing Address - Phone:419-562-7654
Mailing Address - Fax:
Practice Address - Street 1:210 E MARY ST
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-1829
Practice Address - Country:US
Practice Address - Phone:419-562-7654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03136014183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist