Provider Demographics
NPI:1801193792
Name:RAFF, RANDY W (RPH)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:W
Last Name:RAFF
Suffix:
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 1:711 W WINDING RD
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-7284
Mailing Address - Country:US
Mailing Address - Phone:219-866-8058
Mailing Address - Fax:
Practice Address - Street 1:550 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:IN
Practice Address - Zip Code:47978-3007
Practice Address - Country:US
Practice Address - Phone:219-866-4156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26013864A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist