Provider Demographics
NPI:1760757603
Name:JARAVATA, TONI LAN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TONI
Middle Name:LAN
Last Name:JARAVATA
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 1:331 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:PT PLEASANT BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-2548
Mailing Address - Country:US
Mailing Address - Phone:732-903-7274
Mailing Address - Fax:
Practice Address - Street 1:465 ROUTE 70
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-4049
Practice Address - Country:US
Practice Address - Phone:732-262-6309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-10
Last Update Date:2012-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02393000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist