Provider Demographics
NPI:1841585619
Name:RAYBACK, PRISCILLA ANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:ANNE
Last Name:RAYBACK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 S SR 135
Mailing Address - Street 2:TARGET-1364
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-9413
Mailing Address - Country:US
Mailing Address - Phone:317-883-5215
Mailing Address - Fax:317-883-5215
Practice Address - Street 1:895 S STATE ROAD 135
Practice Address - Street 2:TARGET-1364
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-9413
Practice Address - Country:US
Practice Address - Phone:317-883-5215
Practice Address - Fax:317-883-5215
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019502A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist