Provider Demographics
NPI:1821148818
Name:MCRAE INC
Entity Type:Organization
Organization Name:MCRAE INC
Other - Org Name:MCRAE, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:ANTON
Authorized Official - Last Name:MCRAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-332-5712
Mailing Address - Street 1:175 LINCON STREET
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3101
Mailing Address - Country:US
Mailing Address - Phone:307-332-5712
Mailing Address - Fax:
Practice Address - Street 1:745 MAIN STREET
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3101
Practice Address - Country:US
Practice Address - Phone:307-332-5712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY52-00528333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY0863200001Medicare NSC