Provider Demographics
NPI:1306237102
Name:DALE, RAYMOND ROSS JR
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:ROSS
Last Name:DALE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 N 7 HWY
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:MO
Mailing Address - Zip Code:64080-9366
Mailing Address - Country:US
Mailing Address - Phone:816-540-4000
Mailing Address - Fax:816-540-4341
Practice Address - Street 1:1905 N 7 HWY
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:MO
Practice Address - Zip Code:64080-9366
Practice Address - Country:US
Practice Address - Phone:816-540-4000
Practice Address - Fax:816-540-4341
Is Sole Proprietor?:No
Enumeration Date:2015-02-15
Last Update Date:2015-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO028534183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist