MEDICARE: MR. RAYMOND CARVAJAL R.PH.

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	18323	TX

General Provider Information

NPI Number	:	1114237526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAYMOND CARVAJAL R.PH.

Provider Business Mailing Address
First Line	:	3410 ROOSEVELT AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78214-2606
Country	:	US
Telephone Number	:	210-922-2176
Fax Number	:	210-927-4606

Provider Business Practice Location Address
First Line	:	3410 ROOSEVELT AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78214-2606
Country	:	US
Telephone Number	:	210-922-2176
Fax Number	:	210-927-4606

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

Provider Enumeration Date	:	10/19/2010
Last Update Date	:	10/19/2010

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