Provider Demographics
NPI:1598573255
Name:RAYMUNDO, EDDIE UPSORNSOPAKIT
Entity type:Individual
Prefix:
First Name:EDDIE
Middle Name:UPSORNSOPAKIT
Last Name:RAYMUNDO
Suffix:
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 1:4900 CHERRYWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8147
Mailing Address - Country:US
Mailing Address - Phone:415-260-9660
Mailing Address - Fax:
Practice Address - Street 1:4900 CHERRYWOOD WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8147
Practice Address - Country:US
Practice Address - Phone:415-260-9660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist