Provider Demographics
NPI:1871907402
Name:RAIMONDO, LYNNETTE
Entity type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:
Last Name:RAIMONDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 W CAREFREE HWY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3200
Mailing Address - Country:US
Mailing Address - Phone:623-582-5743
Mailing Address - Fax:623-582-8074
Practice Address - Street 1:3130 W CAREFREE HWY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85086-3200
Practice Address - Country:US
Practice Address - Phone:623-582-5743
Practice Address - Fax:623-582-8074
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS020382183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist