MEDICARE: MR. PETER J RAIA JR. RPH

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	18352	NJ

General Provider Information

NPI Number	:	1396897781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER J RAIA JR. RPH

Provider Business Mailing Address
First Line	:	141 OWENO RD
Second Line	:
City	:	MAHWAH
State	:	NJ
Zip	:	07430-2248
Country	:	US
Telephone Number	:	201-785-9500
Fax Number	:	201-785-9600

Provider Business Practice Location Address
First Line	:	310 RIDGE RD
Second Line	:
City	:	MAHWAH
State	:	NJ
Zip	:	07430-3613
Country	:	US
Telephone Number	:	201-785-9500
Fax Number	:	201-785-9600

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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