Provider Demographics
NPI:1770795965
Name:SKULKAN, RAINY W (RPH)
Entity type:Individual
Prefix:MS
First Name:RAINY
Middle Name:W
Last Name:SKULKAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W MOUNTAIN SKY AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85045-0305
Mailing Address - Country:US
Mailing Address - Phone:480-460-9281
Mailing Address - Fax:480-706-6078
Practice Address - Street 1:3616 E RAY RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-7114
Practice Address - Country:US
Practice Address - Phone:480-706-0609
Practice Address - Fax:480-706-6078
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist