Provider Demographics
NPI:1649609033
Name:CARAVAGGIO, RENEE ANN (RPH)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:ANN
Last Name:CARAVAGGIO
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 1:10 SARATOGA CIR
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-2912
Mailing Address - Country:US
Mailing Address - Phone:724-657-1071
Mailing Address - Fax:
Practice Address - Street 1:1209 BOARDMAN POLAND RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-1933
Practice Address - Country:US
Practice Address - Phone:330-758-0571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040907L183500000X
OH03120998183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist