Provider Demographics
NPI:1851626832
Name:RAPER, EUGENIA CONLEY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:EUGENIA
Middle Name:CONLEY
Last Name:RAPER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 BENVENUE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-6342
Mailing Address - Country:US
Mailing Address - Phone:252-212-0381
Mailing Address - Fax:252-212-8138
Practice Address - Street 1:1590 BENVENUE RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-6342
Practice Address - Country:US
Practice Address - Phone:252-212-0381
Practice Address - Fax:252-212-8138
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10896183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0644577Medicaid