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General NPI Number Information
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NPI Number | 1689988784
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Entity Type | Individual
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Provider Name | VALERIE LAUREN RAVENNA PHARM D
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Gender | Female
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Dates
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Enumeration Date | 07/30/2010
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Last Update Date | 04/16/2014
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Provider Practice Location Address
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Address Line | 2900 W OKLAHOMA AVE PHARMACY DEPT
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City | MILWAUKEE
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State | WI
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Zip | 53215-4330
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Country | US
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Telephone | 414-649-6763
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Fax |
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Provider Business Mailing Address
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Address Line | 2929 W BRIARWOOD DR
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City | FRANKLIN
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State | WI
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Zip | 53132-9145
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Country | US
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Telephone | 414-649-6763
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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 | 16045-040
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 051.294107
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License Number State | IL
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