MEDICARE: DR. RAYMOND RALPH VILLALPANDO II PHARMD

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	RPH031738	GA

General Provider Information

NPI Number	:	1568012748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND RALPH VILLALPANDO II PHARMD

Provider Business Mailing Address
First Line	:	40 GARDEN CV
Second Line	:
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-1561
Country	:	US
Telephone Number	:	843-471-8102
Fax Number	:

Provider Business Practice Location Address
First Line	:	2035 MOUNT ZION RD
Second Line	:
City	:	MORROW
State	:	GA
Zip	:	30260-3313
Country	:	US
Telephone Number	:	770-472-4000
Fax Number	:

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

Provider Enumeration Date	:	09/18/2019
Last Update Date	:	09/18/2019

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