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General NPI Number Information
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NPI Number | 1932314192
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Entity Type | Organization
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Legal Business Name | RAYMOND DRUG STORE,INC.
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 112 W.MAIN ST.
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City | RAYMOND
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State | MS
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Zip | 39154-1205
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Country | US
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Telephone | 601-857-8773
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Fax | 601-857-8773
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Provider Business Mailing Address
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Address Line | PO BOX 1205 112 W. MAIN ST
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City | RAYMOND
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State | MS
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Zip | 39154-1205
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Country | US
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Telephone | 601-857-8773
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Fax | 601-857-8773
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Authorized Official
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Title or Position | OWNER
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Name | MR. RAYMOND MARK BAUER
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Credential | R.PH
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Telephone | 601-857-8773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 0082001.1
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License Number State | MS
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