Dalton Thomas Raymond, PHARMACY IMMUNIZER

Key facts

NPI

1083375265

Entity type

Individual (NPI type 1)

Primary specialty

Pharmacy Technician 183700000X

License

5303040850 (MI)

Practice address

3939 S Lapeer Rd
Metamora, MI 48455-8950

Phone

(810) 678-2331

Fax

(810) 678-8781

NPI assigned

Jan 10, 2022

Sex

Male

Sole proprietor

No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rite Aid of Michigan Inc Community/Retail Pharmacy · Metamora, MI · NPI 1619086170
  NPD (past)
• Rite Aid of Michigan Inc Community/Retail Pharmacy · Washington, MI · NPI 1619117405
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 10, 2022.

{
    "created_epoch": "1641772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641772800000",
    "number": "1083375265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5483 DONNA LN",
            "city": "DRYDEN",
            "state": "MI",
            "postal_code": "484289246",
            "telephone_number": "810-441-4767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3939 S LAPEER RD",
            "city": "METAMORA",
            "state": "MI",
            "postal_code": "484558950",
            "telephone_number": "810-678-2331",
            "fax_number": "810-678-8781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAYMOND",
        "first_name": "DALTON",
        "middle_name": "THOMAS",
        "credential": "PHARMACY IMMUNIZER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-10",
        "last_updated": "2022-01-10",
        "certification_date": "2022-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183700000X",
            "taxonomy_group": "",
            "desc": "Pharmacy Technician",
            "state": "MI",
            "license": "5303040850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Metamora, MI

• O2 Rhythm Diagnostics, LLC
• Lawrence Papcun, DDS
• Kathleen Mary Perkins, D.O.
• Pyles Family Dentistry PLLC
• R & H Behavior Consulting LLC
• Kyle Rhein, BCBA
• Rite Aid of Michigan Inc
• Victoria K Rodriguez, OWNER
• Roger C. Gietzen, M.D., P.C.
• Alexander Paul Schultz Jr., DDS

All providers in Metamora, MI · Pharmacy Technician in Michigan