Provider Demographics
NPI:1184277238
Name:HEWITT, RAVEN LAVETTE (PHARMD)
Entity type:Individual
Prefix:
First Name:RAVEN
Middle Name:LAVETTE
Last Name:HEWITT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 KNOLLWOOD ST STE H-116
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1884
Mailing Address - Country:US
Mailing Address - Phone:336-986-4085
Mailing Address - Fax:
Practice Address - Street 1:2795 LEWISVILLE CLEMMONS RD
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8715
Practice Address - Country:US
Practice Address - Phone:336-778-2452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28971183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist