Provider Demographics
NPI:1639779762
Name:VIERTEL, RACHEAL
Entity Type:Individual
Prefix:
First Name:RACHEAL
Middle Name:
Last Name:VIERTEL
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 1:103 N EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:PA
Mailing Address - Zip Code:16049-7313
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 KIMBERLY LN
Practice Address - Street 2:
Practice Address - City:CRANBERRY
Practice Address - State:PA
Practice Address - Zip Code:16319-3134
Practice Address - Country:US
Practice Address - Phone:814-676-1813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP454908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist