Provider Demographics
NPI:1831853183
Name:WRIGHT, RAVEN CIARA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RAVEN
Middle Name:CIARA
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:RAVEN
Other - Middle Name:CIARA
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:4362 MAPLE TER
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60478-5516
Mailing Address - Country:US
Mailing Address - Phone:336-340-8575
Mailing Address - Fax:
Practice Address - Street 1:1633 W 95TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1331
Practice Address - Country:US
Practice Address - Phone:773-445-9277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-23
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051303812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist