Provider Demographics
NPI:1164607123
Name:SHAKERDGE, RACHELLE (R PH)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:SHAKERDGE
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 GLASCO TPKE
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-1072
Mailing Address - Country:US
Mailing Address - Phone:845-679-1057
Mailing Address - Fax:
Practice Address - Street 1:79 MILL HILL RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498-1303
Practice Address - Country:US
Practice Address - Phone:845-679-2222
Practice Address - Fax:845-679-7658
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034536183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist