Active NPI
Kevin Clark Raval, RPH.
- Pharmacist
- Daytona Beach, FL
National Provider Identifier
1104143015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS28664
- Practice address
- 1300 W International Speedway Blvd
Daytona Beach, FL 32114-1440 - Phone
- (386) 252-9659
- NPI assigned
- May 2, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS28664 | FL | Primary |
Addresses
Primary practice location
1300 W International Speedway Blvd
Daytona Beach, FL 32114-1440
Mailing address
6745 Ferri Cir
Port Orange, FL 32128-6036
Phone (386) 304-9866
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS28664 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1272758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1272758400000",
"number": "1104143015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6745 FERRI CIR",
"city": "PORT ORANGE",
"state": "FL",
"postal_code": "321286036",
"telephone_number": "386-304-9866"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 W INTERNATIONAL SPEEDWAY BLVD",
"city": "DAYTONA BEACH",
"state": "FL",
"postal_code": "321141440",
"telephone_number": "386-252-9659"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAVAL",
"first_name": "KEVIN",
"middle_name": "CLARK",
"name_prefix": "Mr.",
"credential": "RPH.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-05-02",
"last_updated": "2010-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS28664",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Daytona Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.