Healthcare Provider Details

I. General information

NPI: 1245953553
Provider Name (Legal Business Name): RAVEN SYMONE CONYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 BROADWAY
EVERETT WA
98201-3044
US

IV. Provider business mailing address

2615 BROADWAY
EVERETT WA
98201-3044
US

V. Phone/Fax

Practice location:
  • Phone: 425-259-6262
  • Fax: 425-258-1485
Mailing address:
  • Phone: 425-259-6262
  • Fax: 425-258-1485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH61183732
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: