Provider Demographics
NPI:1790071611
Name:BERREY, RACHEL (RPH)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:BERREY
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 1:2750 W NEW HAVEN AVE
Mailing Address - Street 2:T-0689
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-3706
Mailing Address - Country:US
Mailing Address - Phone:321-722-9262
Mailing Address - Fax:321-722-9262
Practice Address - Street 1:2750 W NEW HAVEN AVE
Practice Address - Street 2:T-0689
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-3706
Practice Address - Country:US
Practice Address - Phone:321-722-9262
Practice Address - Fax:321-722-9262
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0020667183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist