Healthcare Provider Details

I. General information

NPI: 1134453327
Provider Name (Legal Business Name): RAGHU R EARNI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8235 SW WILSONVILLE RD
WILSONVILLE OR
97070-7718
US

IV. Provider business mailing address

29212 SW TAMI LOOP APT 13
WILSONVILLE OR
97070-6505
US

V. Phone/Fax

Practice location:
  • Phone: 503-682-2701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0011006
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: