Provider Demographics
NPI:1801188586
Name:RACETTE, ROGER L
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:L
Last Name:RACETTE
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 1:16 AMY LN
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-2602
Mailing Address - Country:US
Mailing Address - Phone:413-525-1312
Mailing Address - Fax:
Practice Address - Street 1:577 MEADOW ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-1876
Practice Address - Country:US
Practice Address - Phone:413-592-4696
Practice Address - Fax:413-592-4973
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist