Provider Demographics
NPI:1437912631
Name:DACY, RAVEN NICOLE (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:NICOLE
Last Name:DACY
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1414
Mailing Address - Country:US
Mailing Address - Phone:207-991-9679
Mailing Address - Fax:
Practice Address - Street 1:437 WILSON ST
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1414
Practice Address - Country:US
Practice Address - Phone:207-991-9679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR71886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist