Provider Demographics
NPI:1669729554
Name:RAINES, MATTHEW DEVEN (PHARM-D)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:DEVEN
Last Name:RAINES
Suffix:
Gender:M
Credentials:PHARM-D
Other - Prefix:DR
Other - First Name:MATTHEW
Other - Middle Name:DEVEN
Other - Last Name:RAINES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:418 MOUNTAIN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28714-8432
Mailing Address - Country:US
Mailing Address - Phone:828-678-3914
Mailing Address - Fax:828-678-3945
Practice Address - Street 1:418 MOUNTAIN VIEW RD
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-8432
Practice Address - Country:US
Practice Address - Phone:828-678-3914
Practice Address - Fax:828-678-3945
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14496183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist