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NPI Code Detail

MEDICARE: RAVEN HARRIS

MEDICARE: RAVEN HARRIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistPS52814FL

General Provider Information

NPI Number : 1457951840
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAVEN HARRIS
Provider Business Mailing Address
First Line : 900 SW 66TH AVE
Second Line :
City : NORTH LAUDERDALE
State : FL
Zip : 33068-2622
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7900 W MCNAB RD
Second Line :
City : NORTH LAUDERDALE
State : FL
Zip : 33068-4303
Country : US
Telephone Number : 954-726-7711
Fax Number : 954-726-8789
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2020
Last Update Date : 10/27/2020

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