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General NPI Number Information
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NPI Number | 1598700270
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Entity Type | Individual
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Provider Name | GARY ALLAN RAINES R. PHARM
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Gender | Male
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1685 RICE ST
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City | ROSEVILLE
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State | MN
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Zip | 55113-6802
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Country | US
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Telephone | 651-488-0251
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Fax | 651-488-7517
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Provider Business Mailing Address
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Address Line | 2582 PARKVIEW CT
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55110-5784
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Country | US
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Telephone | 651-653-7715
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Fax | 651-488-7517
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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 | 111319-0
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License Number State | MN
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