Provider Demographics
NPI:1689947335
Name:DECK, RACHAEL A (RPH)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:A
Last Name:DECK
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 1:2880 TRAIL CREST LN
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-4979
Mailing Address - Country:US
Mailing Address - Phone:630-399-2096
Mailing Address - Fax:
Practice Address - Street 1:2880 TRAIL CREST LN
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-4979
Practice Address - Country:US
Practice Address - Phone:630-399-2096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.295547183500000X
WIWI-13565-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist