Provider Demographics
NPI:1316020241
Name:DONATELLE, RACHAEL ANN (PHARM D)
Entity Type:Individual
Prefix:MS
First Name:RACHAEL
Middle Name:ANN
Last Name:DONATELLE
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 1:107 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:WI
Mailing Address - Zip Code:53956-1267
Mailing Address - Country:US
Mailing Address - Phone:608-354-6750
Mailing Address - Fax:
Practice Address - Street 1:107 N HIGH ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:WI
Practice Address - Zip Code:53956-1267
Practice Address - Country:US
Practice Address - Phone:920-326-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14708-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist