Provider Demographics
NPI:1982111282
Name:SPOONER, RAVEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:
Last Name:SPOONER
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 1:10632 TIMBERLANE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70811-1760
Mailing Address - Country:US
Mailing Address - Phone:225-284-4331
Mailing Address - Fax:
Practice Address - Street 1:9960 BLUEBONNET BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-6457
Practice Address - Country:US
Practice Address - Phone:225-768-7775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0022330183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist