Provider Demographics
NPI:1982488169
Name:VINES, RAYMOND (PHARMD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:VINES
Suffix:
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 1:3545 ROTHSCHILD DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-5174
Mailing Address - Country:US
Mailing Address - Phone:850-287-1443
Mailing Address - Fax:
Practice Address - Street 1:1100 E CERVANTES ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-3332
Practice Address - Country:US
Practice Address - Phone:850-438-5984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL66214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist