Healthcare Provider Details

I. General information

NPI: 1376865170
Provider Name (Legal Business Name): ANITA E DRAVININKAS B.S. PHARMACY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 LINCOLNWAY
VALPARAISO IN
46383-5574
US

IV. Provider business mailing address

52 LINCOLNWAY
VALPARAISO IN
46383-5574
US

V. Phone/Fax

Practice location:
  • Phone: 219-462-4146
  • Fax: 855-240-8794
Mailing address:
  • Phone: 219-462-4146
  • Fax: 855-240-8794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26014258
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: