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General NPI Number Information
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NPI Number | 1316539117
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Entity Type | Individual
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Provider Name | LAURA MARVA RPH
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Gender | Female
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Dates
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Enumeration Date | 02/03/2021
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 6693 N CHESTNUT ST
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City | RAVENNA
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State | OH
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Zip | 44266-3922
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Country | US
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Telephone | 330-296-6014
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Fax |
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Provider Business Mailing Address
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Address Line | 3824 BILTZ RD
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City | KENT
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State | OH
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Zip | 44240-6706
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Country | US
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Telephone | 330-819-1373
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03117613
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License Number State | OH
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