Provider Demographics
NPI:1093032906
Name:ENGLISH, RAYMOND DALE (RPH)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:DALE
Last Name:ENGLISH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3107 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-1037
Mailing Address - Country:US
Mailing Address - Phone:575-624-1232
Mailing Address - Fax:
Practice Address - Street 1:3107 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-1037
Practice Address - Country:US
Practice Address - Phone:575-624-1232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-02
Last Update Date:2010-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRPH 3868183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist