Provider Demographics
NPI:1316505639
Name:RAKES, ERIC JAMES (PHARMD, BCGP)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JAMES
Last Name:RAKES
Suffix:
Gender:M
Credentials:PHARMD, BCGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 CEDAR CROSSING TER
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3154
Mailing Address - Country:US
Mailing Address - Phone:804-241-6992
Mailing Address - Fax:
Practice Address - Street 1:1207 CEDAR CROSSING TER
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3154
Practice Address - Country:US
Practice Address - Phone:804-241-6992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-01
Last Update Date:2019-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist