Provider Demographics
NPI:1962614578
Name:RAYMOND UNITED DRUG LLC
Entity type:Organization
Organization Name:RAYMOND UNITED DRUG LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:BRUMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:360-942-2153
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:707 WILLAPA PLACE
Mailing Address - City:RAYMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98577
Mailing Address - Country:US
Mailing Address - Phone:360-942-2153
Mailing Address - Fax:360-942-2939
Practice Address - Street 1:707 WILLAPA PLACE
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:WA
Practice Address - Zip Code:98577
Practice Address - Country:US
Practice Address - Phone:360-942-2153
Practice Address - Fax:360-942-2939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00009276183500000X
WACF00001111333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0055511OtherL & I
WA6065106Medicaid
WA6065106Medicaid
WA1213770001Medicare ID - Type Unspecified