Provider Demographics
NPI:1003688391
Name:VONCH, RACQUEL M
Entity Type:Individual
Prefix:
First Name:RACQUEL
Middle Name:M
Last Name:VONCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3249 PEARL ST APT 2
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60131-2135
Mailing Address - Country:US
Mailing Address - Phone:773-750-2373
Mailing Address - Fax:
Practice Address - Street 1:6430 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-2459
Practice Address - Country:US
Practice Address - Phone:773-725-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.305922183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist