Provider Demographics
NPI:1902893852
Name:RAUL'S VINELAND PHARMACY
Entity Type:Organization
Organization Name:RAUL'S VINELAND PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:MERCURIO
Authorized Official - Suffix:
Authorized Official - Credentials:ETC
Authorized Official - Phone:818-982-7825
Mailing Address - Street 1:11717 SATICOY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-2833
Mailing Address - Country:US
Mailing Address - Phone:818-982-7825
Mailing Address - Fax:818-982-7827
Practice Address - Street 1:11717 SATICOY ST
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-2833
Practice Address - Country:US
Practice Address - Phone:818-982-7825
Practice Address - Fax:818-982-7827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY37601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0579461OtherNABP