Provider Demographics
NPI:1073297537
Name:STOUT, RACHEL KATHERINE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:KATHERINE
Last Name:STOUT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:KATHERINE
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4712 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TN
Mailing Address - Zip Code:37347-3630
Mailing Address - Country:US
Mailing Address - Phone:423-942-3674
Mailing Address - Fax:
Practice Address - Street 1:4712 MAIN ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347-3630
Practice Address - Country:US
Practice Address - Phone:423-942-3674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47303183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist