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General NPI Number Information
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NPI Number | 1821148818
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Entity Type | Organization
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Legal Business Name | MCRAE INC
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 07/09/2008
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Provider Practice Location Address
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Address Line | 745 MAIN STREET
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City | LANDER
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State | WY
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Zip | 82520-3101
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Country | US
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Telephone | 307-332-5712
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Fax |
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Provider Business Mailing Address
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Address Line | 175 LINCON STREET
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City | LANDER
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State | WY
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Zip | 82520-3101
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Country | US
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Telephone | 307-332-5712
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Fax |
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Authorized Official
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Title or Position | PHARMACIST OWNER
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Name | RAYMOND ANTON MCRAE
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Credential |
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Telephone | 307-332-5712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 52-00528
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License Number State | WY
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