Provider Demographics
NPI:1760639108
Name:RAYMOND, MARLYJEAN (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:MARLYJEAN
Middle Name:
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-4026
Mailing Address - Country:US
Mailing Address - Phone:516-496-8550
Mailing Address - Fax:
Practice Address - Street 1:393 FRONT STREET
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3138
Practice Address - Country:US
Practice Address - Phone:516-750-5537
Practice Address - Fax:516-750-5538
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051150183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist