Provider Demographics
NPI:1962788547
Name:RAFAEL, FLORA CEONA
Entity type:Individual
Prefix:MRS
First Name:FLORA
Middle Name:CEONA
Last Name:RAFAEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 QUARRY HEIGHTS WAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1060
Mailing Address - Country:US
Mailing Address - Phone:410-602-8385
Mailing Address - Fax:
Practice Address - Street 1:2560 QUARRY LAKE DRIVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-0000
Practice Address - Country:US
Practice Address - Phone:410-486-4966
Practice Address - Fax:410-486-0447
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15874183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist