MEDICARE: MR. RAYMOND LOUIE B.S.

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	28RI02883800	NJ
2	183500000X	Pharmacist	S12628	AZ
3	183500000X	Pharmacist	RP438108	PA

General Provider Information

NPI Number	:	1508141201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAYMOND LOUIE B.S.

Provider Business Mailing Address
First Line	:	2200 MOUNT HOLLY RD
Second Line	:
City	:	BURLINGTON
State	:	NJ
Zip	:	08016-4100
Country	:	US
Telephone Number	:	609-386-5736
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 MOUNT HOLLY RD
Second Line	:
City	:	BURLINGTON
State	:	NJ
Zip	:	08016-4100
Country	:	US
Telephone Number	:	609-386-5736
Fax Number	:

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

Provider Enumeration Date	:	10/14/2011
Last Update Date	:	10/14/2011

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