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General NPI Number Information
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NPI Number | 1235461476
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Entity Type | Individual
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Provider Name | DUSTIN LEE RAINES PHARMD.
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Gender | Male
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Dates
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Enumeration Date | 02/12/2010
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Last Update Date | 02/12/2010
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Provider Practice Location Address
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Address Line | 3977 E CUMBERLAND RD
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City | BLUEFIELD
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State | WV
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Zip | 24701-5116
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Country | US
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Telephone | 304-325-6750
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Fax | 304-324-4208
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Provider Business Mailing Address
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Address Line | 90 FOUNTAIN SPRING DR
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City | PETERSTOWN
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State | WV
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Zip | 24963-9720
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Country | US
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Telephone | 304-667-4848
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Fax | 304-324-4208
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP0007005
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0202208117
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License Number State | VA
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