MEDICARE: RAVEN GALYEN

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
1	183500000X	Pharmacist	PSI29793	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PSI29793	OTHER	FL	FLORIDA DEPARTMENT OF HEALTH

General Provider Information

NPI Number	:	1710377130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVEN GALYEN

Provider Business Mailing Address
First Line	:	6630 ANCHOR LOOP APT 302
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34212-4432
Country	:	US
Telephone Number	:	540-848-1425
Fax Number	:

Provider Business Practice Location Address
First Line	:	6630 ANCHOR LOOP APT 302
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34212-4432
Country	:	US
Telephone Number	:	540-848-1425
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2015
Last Update Date	:	01/24/2015

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Directions to “ RAVEN GALYEN ” Practice Location

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