Basic Information
| Provider Information | |||||||||
| NPI: | 1366196404 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAINES | ||||||||
| FirstName: | AARON | ||||||||
| MiddleName: | MARCUS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 909 EASTGATE CT | ||||||||
| Address2: | |||||||||
| City: | CUMBERLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 215021811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018761996 | ||||||||
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| Practice Location | |||||||||
| Address1: | 739 PARK ST | ||||||||
| Address2: | |||||||||
| City: | CUMBERLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 215023172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017777670 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2022 | ||||||||
| LastUpdateDate: | 02/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RP0010901 | WV | N | Pharmacy Service Providers | Pharmacist | 183500000X | 25886 | MD | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.