Provider Demographics
NPI:1932314192
Name:RAYMOND DRUG STORE,INC.
Entity Type:Organization
Organization Name:RAYMOND DRUG STORE,INC.
Other - Org Name:RAYMOND DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-857-8773
Mailing Address - Street 1:PO BOX 1205
Mailing Address - Street 2:112 W. MAIN ST
Mailing Address - City:RAYMOND
Mailing Address - State:MS
Mailing Address - Zip Code:39154-1205
Mailing Address - Country:US
Mailing Address - Phone:601-857-8773
Mailing Address - Fax:601-857-8773
Practice Address - Street 1:112 W.MAIN ST.
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:MS
Practice Address - Zip Code:39154-1205
Practice Address - Country:US
Practice Address - Phone:601-857-8773
Practice Address - Fax:601-857-8773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0082001.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy