1114145067 NPI number — MRS. JENNIFER SMITH RAVANESI RPH

Table of content: MRS. JENNIFER SMITH RAVANESI RPH (NPI 1114145067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114145067 NPI number — MRS. JENNIFER SMITH RAVANESI RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAVANESI
Provider First Name:
JENNIFER
Provider Middle Name:
SMITH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114145067
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 MARTHAS WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST GROVE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19390-1359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-869-5670
Provider Business Mailing Address Fax Number:
302-234-9125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ROUTE 7 & VALLEY ROAD
Provider Second Line Business Practice Location Address:
LANTANA SQUARE
Provider Business Practice Location Address City Name:
HOCKESSIN
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-234-9006
Provider Business Practice Location Address Fax Number:
302-234-9125
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  A1-0003140 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com