Provider Demographics
NPI:1902235112
Name:GILLEECE, RAEVEN RENEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:RAEVEN
Middle Name:RENEE
Last Name:GILLEECE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:RAEVEN
Other - Middle Name:RENEE
Other - Last Name:RUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1741 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-1201
Mailing Address - Country:US
Mailing Address - Phone:412-835-3549
Mailing Address - Fax:
Practice Address - Street 1:1741 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-1201
Practice Address - Country:US
Practice Address - Phone:412-835-3549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP447540183500000X
OH03132567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist