Provider Demographics
NPI:1205869914
Name:RAYMOND PHARMACY CORP
Entity type:Organization
Organization Name:RAYMOND PHARMACY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REPRESENTATIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-752-5377
Mailing Address - Street 1:15740 SW 72ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5060
Mailing Address - Country:US
Mailing Address - Phone:305-752-5377
Mailing Address - Fax:305-752-5388
Practice Address - Street 1:15740 SW 72ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-5060
Practice Address - Country:US
Practice Address - Phone:305-752-5377
Practice Address - Fax:305-752-5388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH215243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031191000Medicaid
FL031191001Medicaid
FL5557270001Medicare NSC