MEDICARE: MR. DONALD RAY HOUSTON 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	183500000X	Pharmacist	PS12647	FL

General Provider Information

NPI Number	:	1720002462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONALD RAY HOUSTON RPH.

Provider Business Mailing Address
First Line	:	297 N MARION AVE
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-2866
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	297 N MARION AVE
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-2866
Country	:	US
Telephone Number	:	386-752-1793
Fax Number	:

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	08/06/2007

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