Provider Demographics
NPI:1841390499
Name:MACRAE, RICHARD ANDREWS (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ANDREWS
Last Name:MACRAE
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 1:9583 EMERALD RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:ONEKAMA
Mailing Address - State:MI
Mailing Address - Zip Code:49675-9616
Mailing Address - Country:US
Mailing Address - Phone:231-889-3531
Mailing Address - Fax:
Practice Address - Street 1:401 MAIN ST
Practice Address - Street 2:C/O COMMUNITY DRUG BOX 753
Practice Address - City:FRANKFORT
Practice Address - State:MI
Practice Address - Zip Code:49635-9142
Practice Address - Country:US
Practice Address - Phone:231-352-4471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024759183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302024759OtherRPH PERM ID NUMBER
MIM260738067741OtherSTATE DRIVERS LIC.