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NPI Code Detail

MEDICARE: RAVEN CALLAS PHARMD RPH

MEDICARE: RAVEN CALLAS PHARMD RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist3347WY

General Provider Information

NPI Number : 1356659981
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAVEN CALLAS PHARMD RPH
Provider Business Mailing Address
First Line : 3112 E GRAND AVE
Second Line :
City : LARAMIE
State : WY
Zip : 82070-5141
Country : US
Telephone Number : 307-745-7246
Fax Number :
Provider Business Practice Location Address
First Line : 3112 E GRAND AVE
Second Line :
City : LARAMIE
State : WY
Zip : 82070-5141
Country : US
Telephone Number : 307-745-7246
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2010
Last Update Date : 09/16/2010

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Directions to “ RAVEN CALLAS PHARMD RPH” Practice Location

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