Healthcare Provider Details

I. General information

NPI: 1477688091
Provider Name (Legal Business Name): MR. RAYMOND RUSSELL HYNDS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 01/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1673 HIGHWAY 64 NE
NEW SALISBURY IN
47161-8439
US

IV. Provider business mailing address

1725 CEDAR LN NW
CORYDON IN
47112-2104
US

V. Phone/Fax

Practice location:
  • Phone: 812-347-3188
  • Fax: 812-347-3078
Mailing address:
  • Phone: 812-347-3188
  • Fax: 812-347-3078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26012604A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number012081
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.028541
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: