Provider Demographics
NPI:1467140251
Name:RAV PHARMA LLC
Entity Type:Organization
Organization Name:RAV PHARMA LLC
Other - Org Name:HOMETOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ASHISH
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPOOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-515-0929
Mailing Address - Street 1:PO BOX 600786
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32260-0786
Mailing Address - Country:US
Mailing Address - Phone:904-515-0929
Mailing Address - Fax:
Practice Address - Street 1:450077 SR 200
Practice Address - Street 2:SUITE 4
Practice Address - City:CALLAHAN
Practice Address - State:FL
Practice Address - Zip Code:32011
Practice Address - Country:US
Practice Address - Phone:904-515-0929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-28
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy