Provider Demographics
NPI:1194072975
Name:RAINEY, STEPHEN JOHN JR (PHARMD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JOHN
Last Name:RAINEY
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-2704
Mailing Address - Country:US
Mailing Address - Phone:203-877-6774
Mailing Address - Fax:203-882-1420
Practice Address - Street 1:1360 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-2704
Practice Address - Country:US
Practice Address - Phone:203-877-6774
Practice Address - Fax:203-882-1420
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0012333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist