Provider Demographics
NPI:1942522040
Name:RAVA, JULIA ELENA
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ELENA
Last Name:RAVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-2340
Mailing Address - Country:US
Mailing Address - Phone:631-265-7888
Mailing Address - Fax:631-265-6935
Practice Address - Street 1:322 2ND AVE
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-2340
Practice Address - Country:US
Practice Address - Phone:631-265-7888
Practice Address - Fax:631-265-6935
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist