Provider Demographics
NPI:1508380981
Name:DRAVIS, RENEE (RPH)
Entity Type:Individual
Prefix:MISS
First Name:RENEE
Middle Name:
Last Name:DRAVIS
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 1:7652 ORLANDO DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-6629
Mailing Address - Country:US
Mailing Address - Phone:440-845-3972
Mailing Address - Fax:
Practice Address - Street 1:8160 MACEDONIA COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-1843
Practice Address - Country:US
Practice Address - Phone:330-468-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-18486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist