Provider Demographics
NPI:1982133419
Name:POON, RAYMOND C (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:C
Last Name:POON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-2502
Mailing Address - Country:US
Mailing Address - Phone:323-255-5130
Mailing Address - Fax:323-255-5293
Practice Address - Street 1:1030 COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-2502
Practice Address - Country:US
Practice Address - Phone:323-255-5130
Practice Address - Fax:323-255-5293
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist