Provider Demographics
NPI:1962550657
Name:ARCHAMBAULT, RAOUL IV (PHARMD)
Entity type:Individual
Prefix:
First Name:RAOUL
Middle Name:
Last Name:ARCHAMBAULT
Suffix:IV
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 1:1145 STURGIS STREET
Mailing Address - Street 2:NAVAL HOSPITAL (ATTN PROFESSIONAL AFFAIRS)
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92278-8250
Mailing Address - Country:US
Mailing Address - Phone:760-830-2135
Mailing Address - Fax:
Practice Address - Street 1:1145 STURGIS STREET
Practice Address - Street 2:NAVAL HOSPITAL (ATTN PROFESSIONAL AFFAIRS)
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92278-8250
Practice Address - Country:US
Practice Address - Phone:760-830-2135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH04596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist