Provider Demographics
NPI:1851671978
Name:RAVERT, MARIA ANGELA (RPH)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ANGELA
Last Name:RAVERT
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 1:735 MAXINE DR
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-5814
Mailing Address - Country:US
Mailing Address - Phone:570-249-4608
Mailing Address - Fax:
Practice Address - Street 1:590 COAL ST
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1339
Practice Address - Country:US
Practice Address - Phone:610-377-9730
Practice Address - Fax:610-377-9510
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP036897L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist