Provider Demographics
NPI:1902181878
Name:RAVELA, NAVEEN KUMAR (RPH)
Entity Type:Individual
Prefix:
First Name:NAVEEN
Middle Name:KUMAR
Last Name:RAVELA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 N DEMAREE ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-7147
Mailing Address - Country:US
Mailing Address - Phone:559-734-9376
Mailing Address - Fax:559-734-5632
Practice Address - Street 1:3010 N DEMAREE ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-7147
Practice Address - Country:US
Practice Address - Phone:559-734-9376
Practice Address - Fax:559-734-5632
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist