Provider Demographics
NPI:1083337059
Name:EASTER, RAVEN TIARA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RAVEN
Middle Name:TIARA
Last Name:EASTER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2438 RED VINTAGE CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-0939
Mailing Address - Country:US
Mailing Address - Phone:615-973-3077
Mailing Address - Fax:
Practice Address - Street 1:7735 FARMINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2901
Practice Address - Country:US
Practice Address - Phone:901-754-7864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD16304183500000X
TN46559183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist