Provider Demographics
NPI:1629529482
Name:KRAJEWSKI, RACHEL
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:KRAJEWSKI
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 1:31007 INTERSTATE 10 W
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-9264
Mailing Address - Country:US
Mailing Address - Phone:830-981-4774
Mailing Address - Fax:
Practice Address - Street 1:31007 INTERSTATE 10 W
Practice Address - Street 2:SUITE 108
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-9264
Practice Address - Country:US
Practice Address - Phone:830-981-4774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX54832OtherTSBP