Provider Demographics
NPI:1760826325
Name:CRAVEN, REBECCA BOYETTE (RPH)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:BOYETTE
Last Name:CRAVEN
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 1:1200 WITCHDUCK BAY CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-5621
Mailing Address - Country:US
Mailing Address - Phone:757-567-0798
Mailing Address - Fax:
Practice Address - Street 1:1200 WITCHDUCK BAY CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5621
Practice Address - Country:US
Practice Address - Phone:757-567-0798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011622183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist