Provider Demographics
NPI:1033409586
Name:THORNBURG, RACHELLE LEE (RPH)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:LEE
Last Name:THORNBURG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54040 FULTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:OH
Mailing Address - Zip Code:43906-9415
Mailing Address - Country:US
Mailing Address - Phone:740-676-7513
Mailing Address - Fax:
Practice Address - Street 1:428 34TH ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:OH
Practice Address - Zip Code:43906-1538
Practice Address - Country:US
Practice Address - Phone:740-676-5621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03118771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist