Provider Demographics
NPI:1811608185
Name:TARVER, RACEY LASHAY (CPHT)
Entity type:Individual
Prefix:MISS
First Name:RACEY
Middle Name:LASHAY
Last Name:TARVER
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5036 LIMING AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-1658
Mailing Address - Country:US
Mailing Address - Phone:407-493-8504
Mailing Address - Fax:
Practice Address - Street 1:6217 SILVER STAR RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-4229
Practice Address - Country:US
Practice Address - Phone:407-298-0404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT18137183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician