MEDICARE: TRINA RAYMOND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	34217	TX

General Provider Information

NPI Number	:	1215240692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRINA RAYMOND

Provider Business Mailing Address
First Line	:	3663 BRIARPARK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-5205
Country	:	US
Telephone Number	:	713-268-3630
Fax Number	:	623-869-1717

Provider Business Practice Location Address
First Line	:	4215 S CARRIER PKWY
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-3203
Country	:	US
Telephone Number	:	972-266-7056
Fax Number	:	972-266-7087

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2010
Last Update Date	:	07/14/2010

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