Provider Demographics
NPI:1457743585
Name:KRAUCUNAS, RAYMOND (RPH)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:KRAUCUNAS
Suffix:
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 1:102 E HIVELY AVE.
Mailing Address - Street 2:WALGREENS
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46517
Mailing Address - Country:US
Mailing Address - Phone:574-522-2197
Mailing Address - Fax:574-522-9352
Practice Address - Street 1:102 E HIVELY AVE.
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46517
Practice Address - Country:US
Practice Address - Phone:574-522-2197
Practice Address - Fax:574-522-9352
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019788A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist