Provider Demographics
NPI:1164022778
Name:LEARY, RACHELLE LOUISE
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:LOUISE
Last Name:LEARY
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 1:123 CHARLOTTE WHITE ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-4317
Mailing Address - Country:US
Mailing Address - Phone:774-930-2046
Mailing Address - Fax:
Practice Address - Street 1:506 STATE RD
Practice Address - Street 2:
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1802
Practice Address - Country:US
Practice Address - Phone:508-984-7774
Practice Address - Fax:508-991-4215
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH22810183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist