Provider Demographics
NPI:1851064539
Name:RAINES, RAY HARRELL (RPH)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:HARRELL
Last Name:RAINES
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 1:3351 S PEAK DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-9692
Mailing Address - Country:US
Mailing Address - Phone:910-908-2239
Mailing Address - Fax:910-908-2243
Practice Address - Street 1:3351 S PEAK DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-9692
Practice Address - Country:US
Practice Address - Phone:910-908-2239
Practice Address - Fax:910-908-2243
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist