MEDICARE: RAYNA STANDARD

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	0015470	GA

General Provider Information

NPI Number	:	1669000162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYNA STANDARD

Provider Business Mailing Address
First Line	:	518 HARPER RD
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30252-4949
Country	:	US
Telephone Number	:	770-954-9511
Fax Number	:

Provider Business Practice Location Address
First Line	:	5900 E LAKE PKWY
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-4802
Country	:	US
Telephone Number	:	770-954-4389
Fax Number	:

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

Provider Enumeration Date	:	03/30/2020
Last Update Date	:	03/30/2020

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Directions to “ RAYNA STANDARD ” Practice Location

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