Provider Demographics
NPI:1114145067
Name:RAVANESI, JENNIFER SMITH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SMITH
Last Name:RAVANESI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 MARTHAS WAY
Mailing Address - Street 2:
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-1359
Mailing Address - Country:US
Mailing Address - Phone:610-869-5670
Mailing Address - Fax:302-234-9125
Practice Address - Street 1:ROUTE 7 & VALLEY ROAD
Practice Address - Street 2:LANTANA SQUARE
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707
Practice Address - Country:US
Practice Address - Phone:302-234-9006
Practice Address - Fax:302-234-9125
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist