Provider Demographics
NPI:1831451095
Name:GARCIA, RAISA M
Entity type:Individual
Prefix:MRS
First Name:RAISA
Middle Name:M
Last Name:GARCIA
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 1:1302 BRIDFORD PKWY
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-2654
Mailing Address - Country:US
Mailing Address - Phone:336-632-4503
Mailing Address - Fax:336-294-5922
Practice Address - Street 1:1302 BRIDFORD PKWY
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-2654
Practice Address - Country:US
Practice Address - Phone:336-632-4503
Practice Address - Fax:336-294-5922
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6648183500000X
PR2109183500000X
PARP036702R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist