Provider Demographics
NPI:1861066235
Name:RAAB, SAMUEL (PTN)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:RAAB
Suffix:
Gender:M
Credentials:PTN
Other - Prefix:
Other - First Name:SOREN
Other - Middle Name:
Other - Last Name:KESTREL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:560 JENNER DR
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-1517
Mailing Address - Country:US
Mailing Address - Phone:269-673-2181
Mailing Address - Fax:269-686-7861
Practice Address - Street 1:560 JENNER DR
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-1517
Practice Address - Country:US
Practice Address - Phone:269-673-2181
Practice Address - Fax:269-686-7861
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303021689183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician