Healthcare Provider Details

I. General information

NPI: 1588263412
Provider Name (Legal Business Name): MICHAEL RAQUE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 VINE ST
CINCINNATI OH
45202-1141
US

IV. Provider business mailing address

1014 VINE ST
CINCINNATI OH
45202-1141
US

V. Phone/Fax

Practice location:
  • Phone: 513-387-1341
  • Fax:
Mailing address:
  • Phone: 513-387-1341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number013660
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: