Healthcare Provider Details

I. General information

NPI: 1285722546
Provider Name (Legal Business Name): PHILIP M MCRAE MS, RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4823 SKYCREST WAY
SANTA ROSA CA
95405-8798
US

IV. Provider business mailing address

4823 SKYCREST WAY
SANTA ROSA CA
95405-8798
US

V. Phone/Fax

Practice location:
  • Phone: 707-571-4784
  • Fax: 707-571-4701
Mailing address:
  • Phone: 707-571-4184
  • Fax: 707-571-4701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 25588
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: