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General NPI Number Information
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NPI Number | 1396208757
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Entity Type | Organization
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Legal Business Name | REVAN INC
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Dates
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Enumeration Date | 04/11/2019
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 5601 NW 72ND ST STE 142
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City | WARR ACRES
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State | OK
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Zip | 73132-5924
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Country | US
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Telephone | 888-773-8267
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Fax | 888-998-8267
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Provider Business Mailing Address
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Address Line | 5601 NW 72ND ST STE 142
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City | WARR ACRES
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State | OK
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Zip | 73132-5924
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PHARMACIST IN CHARGE
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Name | JASON ROBERT REVEL
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Credential | PHARM.D.
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Telephone | 405-896-7978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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