Raven Forrest
Individual provider Active NPI Pharmacist · Berkeley, MO
NPI 1437668464 · NPPES record last updated Sep 21, 2017
Key facts
- NPI
- 1437668464
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 2012004645 (MO)
- Practice address
- 8640 Evans Ave
Berkeley, MO 63134-2903 - Phone
- (866) 997-3677
- NPI assigned
- Sep 21, 2017
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2012004645 | MO | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2012004645 | MO | Yes |
Addresses
Primary practice location
8640 Evans Ave
Berkeley, MO 63134-2903
Mailing address
8640 Evans Ave Ste a
Berkeley, MO 63134-2903
Phone (866) 997-3688
Other providers in Berkeley, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 21, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.