Provider Demographics
NPI:1518408053
Name:BOSTICK-MAYWEATHER, RACHAEL ELISE
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:ELISE
Last Name:BOSTICK-MAYWEATHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:ELISE
Other - Last Name:BOSTICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:17330 DANBURY BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-5926
Mailing Address - Country:US
Mailing Address - Phone:281-806-9240
Mailing Address - Fax:281-859-9849
Practice Address - Street 1:17330 DANBURY BRIDGE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-5926
Practice Address - Country:US
Practice Address - Phone:281-806-9240
Practice Address - Fax:281-859-9849
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39811183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist