=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578030425
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE RAZON RAGUINDIN PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2018
-----------------------------------------------------
Last Update Date | 12/09/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6135 ROOSEVELT HWY
-----------------------------------------------------
City | WARM SPRINGS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31830-2757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-655-5418
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20884 FREEDOM RUN DR
-----------------------------------------------------
City | LEXINGTON PARK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20653-2497
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-904-8375
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH031954
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 25877
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------