MEDICARE: TIMOTHY RAYMOND PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	15524	NV

General Provider Information

NPI Number	:	1043297948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY RAYMOND PHARM.D.

Provider Business Mailing Address
First Line	:	7500 FLAT ROCK ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-4514
Country	:	US
Telephone Number	:	702-528-2215
Fax Number	:

Provider Business Practice Location Address
First Line	:	2316 W CHARLESTON BLVD
Second Line	:	STE. 174
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2149
Country	:	US
Telephone Number	:	702-877-8605
Fax Number	:	702-258-8542

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	07/08/2007

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