Individual
MR. RAYMOND DWIGHT BANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
27691 CAPSHAW RD, HARVEST, AL 35749-7403
(256) 230-3416
(256) 230-3407
Mailing address
27691 CAPSHAW RD, HARVEST, AL 35749-7403
(256) 230-3416
(256) 230-3407
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10312
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100003700
—
AL
Enumeration date
10/31/2015
Last updated
10/31/2015
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