Healthcare Provider Details

I. General information

NPI: 1316938491
Provider Name (Legal Business Name): JACK H. RABER PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7890 E SPRING ST
LONG BEACH CA
90815-1622
US

IV. Provider business mailing address

PO BOX 3206
SEAL BEACH CA
90740-2206
US

V. Phone/Fax

Practice location:
  • Phone: 562-596-8753
  • Fax: 707-897-1657
Mailing address:
  • Phone: 562-596-8753
  • Fax: 707-897-1657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number29591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: