Provider Demographics
NPI:1184993362
Name:MCBRIDE, RAYMOND KEVIN
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:KEVIN
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 SANDPIPER CT N
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-6336
Mailing Address - Country:US
Mailing Address - Phone:219-395-4426
Mailing Address - Fax:
Practice Address - Street 1:200 ALFRED ST
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-6202
Practice Address - Country:US
Practice Address - Phone:219-872-6200
Practice Address - Fax:219-879-2915
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-18
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018378A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist