Provider Demographics
NPI:1629673918
Name:RAWLS, ARIELLE
Entity Type:Individual
Prefix:
First Name:ARIELLE
Middle Name:
Last Name:RAWLS
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 1:65 LENOX RD APT 1I
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-2363
Mailing Address - Country:US
Mailing Address - Phone:917-922-5041
Mailing Address - Fax:
Practice Address - Street 1:1091 MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2305
Practice Address - Country:US
Practice Address - Phone:716-954-8877
Practice Address - Fax:716-954-8854
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist