Healthcare Provider Details

I. General information

NPI: 1376454157
Provider Name (Legal Business Name): RAV PHARMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450077 STATE ROAD 200 STE 4
CALLAHAN FL
32011-3863
US

IV. Provider business mailing address

450077 STATE ROAD 200 STE 4
CALLAHAN FL
32011-3863
US

V. Phone/Fax

Practice location:
  • Phone: 904-515-0929
  • Fax: 904-515-5609
Mailing address:
  • Phone: 904-515-0929
  • Fax: 904-515-5609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. ASHISH KAPOOR
Title or Position: AO
Credential:
Phone: 904-515-0929