MEDICARE: MR. JOEL H RAIMAN 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	1835P1200X	Pharmacotherapy Pharmacist	10502	NV

General Provider Information

NPI Number	:	1528203254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOEL H RAIMAN RPH

Provider Business Mailing Address
First Line	:	2901 BERNARDO LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4054
Country	:	US
Telephone Number	:	702-630-4082
Fax Number	:	702-630-4082

Provider Business Practice Location Address
First Line	:	2901 BERNARDO LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4054
Country	:	US
Telephone Number	:	702-630-4082
Fax Number	:	702-630-4082

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

Provider Enumeration Date	:	12/09/2008
Last Update Date	:	12/09/2008

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