Provider Demographics
NPI:1285722546
Name:MCRAE, PHILIP M (MS, RPH)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:M
Last Name:MCRAE
Suffix:
Gender:M
Credentials:MS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4823 SKYCREST WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-8798
Mailing Address - Country:US
Mailing Address - Phone:707-571-4184
Mailing Address - Fax:707-571-4701
Practice Address - Street 1:4823 SKYCREST WAY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-8798
Practice Address - Country:US
Practice Address - Phone:707-571-4784
Practice Address - Fax:707-571-4701
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 25588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist