Provider Demographics
NPI:1710457734
Name:RAUCH, ANGELA MICHELLE
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MICHELLE
Last Name:RAUCH
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 1:114 SKUNK HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:PA
Mailing Address - Zip Code:17760-9548
Mailing Address - Country:US
Mailing Address - Phone:570-660-1625
Mailing Address - Fax:
Practice Address - Street 1:1440 ALLEGHENY ST
Practice Address - Street 2:
Practice Address - City:JERSEY SHORE
Practice Address - State:PA
Practice Address - Zip Code:17740-1116
Practice Address - Country:US
Practice Address - Phone:570-398-7757
Practice Address - Fax:570-398-4694
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040252L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist