Provider Demographics
NPI:1760088793
Name:UPTON, RACHELLE PATRICIA
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:PATRICIA
Last Name:UPTON
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 1:60 N STYGLER RD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2435
Mailing Address - Country:US
Mailing Address - Phone:614-475-2014
Mailing Address - Fax:614-475-7021
Practice Address - Street 1:60 N STYGLER RD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-2435
Practice Address - Country:US
Practice Address - Phone:614-475-2014
Practice Address - Fax:614-475-7021
Is Sole Proprietor?:No
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-24597183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist