Provider Demographics
NPI:1033628011
Name:BANALES, RACHEL GRACE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:GRACE
Last Name:BANALES
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14559 WOODWORTH WAY
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-0835
Mailing Address - Country:US
Mailing Address - Phone:760-596-7157
Mailing Address - Fax:
Practice Address - Street 1:20288 US HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2937
Practice Address - Country:US
Practice Address - Phone:760-240-5501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA77145OtherCA BOARD OF PHARMACY