Provider Demographics
NPI:1992182935
Name:RAQUIPISO, LALAINE (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:LALAINE
Middle Name:
Last Name:RAQUIPISO
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2064 FOXCLOVE DR
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-6760
Mailing Address - Country:US
Mailing Address - Phone:209-836-0551
Mailing Address - Fax:
Practice Address - Street 1:2064 FOXCLOVE DR
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-6760
Practice Address - Country:US
Practice Address - Phone:209-836-0551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 61134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist