Provider Demographics
NPI:1235474636
Name:RAVIS, THOMAS JON (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JON
Last Name:RAVIS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 GARTON PLZ
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-2129
Mailing Address - Country:US
Mailing Address - Phone:304-269-3737
Mailing Address - Fax:304-269-3770
Practice Address - Street 1:4 GARTON PLZ
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-2129
Practice Address - Country:US
Practice Address - Phone:304-269-3737
Practice Address - Fax:304-269-3770
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0008023183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001887Medicaid
WV3810001887Medicaid