Provider Demographics
NPI:1306144118
Name:RAVYN, VIPA (RPH,PHD)
Entity type:Individual
Prefix:
First Name:VIPA
Middle Name:
Last Name:RAVYN
Suffix:
Gender:F
Credentials:RPH,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11444 W SAND COVE RD
Mailing Address - Street 2:
Mailing Address - City:SELBYVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19975-3730
Mailing Address - Country:US
Mailing Address - Phone:302-764-8806
Mailing Address - Fax:
Practice Address - Street 1:12524 OCEAN GTWY
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842-9690
Practice Address - Country:US
Practice Address - Phone:410-213-0159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19363183500000X
MI5302037984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist