Provider Demographics
NPI:1912129594
Name:PUTNAM, RALEIGH JACKSON JR (REG PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:RALEIGH
Middle Name:JACKSON
Last Name:PUTNAM
Suffix:JR
Gender:M
Credentials:REG PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7051 BLOOMSBURY CT SW
Mailing Address - Street 2:
Mailing Address - City:OCEAN ISLE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28469-3653
Mailing Address - Country:US
Mailing Address - Phone:910-575-4335
Mailing Address - Fax:
Practice Address - Street 1:7051 BLOOMSBURY CT SW
Practice Address - Street 2:
Practice Address - City:OCEAN ISLE BEACH
Practice Address - State:NC
Practice Address - Zip Code:28469-3653
Practice Address - Country:US
Practice Address - Phone:910-575-4335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC08686183500000X
FLPS13583183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist