Provider Demographics
NPI:1396897781
Name:RAIA, PETER J JR (RPH)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:J
Last Name:RAIA
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 OWENO RD
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-2248
Mailing Address - Country:US
Mailing Address - Phone:201-785-9500
Mailing Address - Fax:201-785-9600
Practice Address - Street 1:310 RIDGE RD
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-3613
Practice Address - Country:US
Practice Address - Phone:201-785-9500
Practice Address - Fax:201-785-9600
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18352183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist