Provider Demographics
NPI:1619198595
Name:ANTEL, RAYMOND LOUIS JR (REGISTERED PHARMACIS)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:LOUIS
Last Name:ANTEL
Suffix:JR
Gender:M
Credentials:REGISTERED PHARMACIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 463
Mailing Address - Street 2:42 S CENTER ST
Mailing Address - City:BEULAH
Mailing Address - State:MI
Mailing Address - Zip Code:49617
Mailing Address - Country:US
Mailing Address - Phone:231-882-5567
Mailing Address - Fax:
Practice Address - Street 1:10587 MAIN ST
Practice Address - Street 2:
Practice Address - City:HONOUR
Practice Address - State:MI
Practice Address - Zip Code:49640
Practice Address - Country:US
Practice Address - Phone:231-325-2735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302019334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist