Provider Demographics
NPI:1710562400
Name:MARTIN, RACHEL HODCZAK (RPH)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:HODCZAK
Last Name:MARTIN
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 1:345 W HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-6777
Mailing Address - Country:US
Mailing Address - Phone:330-592-9162
Mailing Address - Fax:
Practice Address - Street 1:7235 MARKET PLACE DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OH
Practice Address - Zip Code:44202-8758
Practice Address - Country:US
Practice Address - Phone:330-562-7084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-14
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040941L183500000X
OH03324047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist