Provider Demographics
NPI:1922373471
Name:RAVITCH, ALAN JAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JAN
Last Name:RAVITCH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2081 N VALLEJO WAY
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-1437
Mailing Address - Country:US
Mailing Address - Phone:909-285-6776
Mailing Address - Fax:
Practice Address - Street 1:22633 SAVI RANCH PKWY
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-4647
Practice Address - Country:US
Practice Address - Phone:714-279-1580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist