Michaela Camille Raes, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

58966 Issued in TX

Practice address

3495 Bailey Ave
Buffalo, NY 14215-1129

Phone

(716) 862-8523

NPI assigned

Aug 5, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Michaela Camille Lysogorski Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576886400000",
    "number": "1528512787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3495 BAILEY AVE",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142151129",
            "telephone_number": "716-862-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3495 BAILEY AVE",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142151129",
            "telephone_number": "716-862-8523"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7400 Merton Minter St",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782294404",
            "country_code": "US",
            "telephone_number": "210-617-5300 x16356",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAES",
        "first_name": "MICHAELA",
        "middle_name": "CAMILLE",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-05",
        "last_updated": "2019-12-21",
        "certification_date": "2019-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "062013",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "58966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHAELA",
            "last_name": "LYSOGORSKI",
            "middle_name": "CAMILLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Philip J Rados, M.D.
• Marija Radovic, M.D.
• Vladan Radovic, M.D.
• Mohammed Radwan
• Christopher David Radziwon, PH.D
• Rafael Medina, MD, PLLC
• Michael B Raftree, D.O.
• Diana Ragau, MS SPECIAL EDUCATION
• Maya Raghavan
• Emilie Amanda Rago

• Pharmacist in Buffalo, NY
• Providers in Buffalo, NY by specialty
• Pharmacist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.