Provider Demographics
NPI:1467178608
Name:BROWN, RACHELLE CRAWSHAW
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:CRAWSHAW
Last Name:BROWN
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 1:3909 CHALLENGER AVE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-6733
Mailing Address - Country:US
Mailing Address - Phone:540-977-1376
Mailing Address - Fax:540-977-1693
Practice Address - Street 1:3909 CHALLENGER AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-6733
Practice Address - Country:US
Practice Address - Phone:540-977-1376
Practice Address - Fax:540-977-1693
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202012092183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist