Healthcare Provider Details

I. General information

NPI: 1194072975
Provider Name (Legal Business Name): STEPHEN JOHN RAINEY JR. PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 BOSTON POST RD
MILFORD CT
06460-2704
US

IV. Provider business mailing address

1360 BOSTON POST RD
MILFORD CT
06460-2704
US

V. Phone/Fax

Practice location:
  • Phone: 203-877-6774
  • Fax: 203-882-1420
Mailing address:
  • Phone: 203-877-6774
  • Fax: 203-882-1420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0012333
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: