Provider Demographics
NPI:1538482542
Name:REYENTOVICH, RACHEL (RPH)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:REYENTOVICH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 BRIGHTON BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6457
Mailing Address - Country:US
Mailing Address - Phone:718-332-5881
Mailing Address - Fax:718-891-7620
Practice Address - Street 1:424 BRIGHTON BEACH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6457
Practice Address - Country:US
Practice Address - Phone:718-332-5881
Practice Address - Fax:718-891-7620
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY034596OtherSTATE LIC #