Organization Name: | MICHAEL RAYBURN |
NPI Number: | 1649311374 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL RABURN (OWNER) |
Mailing Address: | 123 W Avenue A Lovington |
State: | NM US |
Postal Code: | 882604211 |
Phone Number: | 5753962311 |
Fax Number: | 5753962321 |
NPI Enumeration Date: | 02/08/2007 |
NPI Last Update Date: | 03/28/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 3336C0004X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Pharmacy |
Taxonomy Specialization: | Compounding Pharmacy |
Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |