Provider Demographics
NPI:1750680906
Name:RAKE, HAMILTON KEITH
Entity Type:Individual
Prefix:DR
First Name:HAMILTON
Middle Name:KEITH
Last Name:RAKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CARRIAGE HILL LN
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-8024
Mailing Address - Country:US
Mailing Address - Phone:304-440-0022
Mailing Address - Fax:
Practice Address - Street 1:2418 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-2008
Practice Address - Country:US
Practice Address - Phone:304-675-1624
Practice Address - Fax:304-675-8193
Is Sole Proprietor?:No
Enumeration Date:2011-03-26
Last Update Date:2011-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist