MEDICARE: RAYMOND RICHARD WASSON 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	RPH 25826	CA

General Provider Information

NPI Number	:	1609177872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND RICHARD WASSON R.PH.

Provider Business Mailing Address
First Line	:	PO BOX 1056
Second Line	:
City	:	KINGS BEACH
State	:	CA
Zip	:	96143-1056
Country	:	US
Telephone Number	:	530-546-0186
Fax Number	:	530-546-0277

Provider Business Practice Location Address
First Line	:	7815 NORTH LAKE BLVD.
Second Line	:
City	:	KINGS BEACH
State	:	CA
Zip	:	96143
Country	:	US
Telephone Number	:	530-546-0186
Fax Number	:	530-546-0277

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

Provider Enumeration Date	:	11/04/2010
Last Update Date	:	11/04/2010

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