Provider Demographics
NPI:1649474008
Name:RACINE, DAVID (RPH)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:RACINE
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 1:10225 MALVERN CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-6087
Mailing Address - Country:US
Mailing Address - Phone:703-369-5045
Mailing Address - Fax:
Practice Address - Street 1:2094 GAITHER RD
Practice Address - Street 2:HFZ-300
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4009
Practice Address - Country:US
Practice Address - Phone:240-276-0640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist