Provider Demographics
NPI:1790157345
Name:AVERILL, RACHAEL (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:
Last Name:AVERILL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:PULLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3701 E EVERGREEN DR
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-7402
Mailing Address - Country:US
Mailing Address - Phone:920-739-5900
Mailing Address - Fax:
Practice Address - Street 1:3701 E EVERGREEN DR
Practice Address - Street 2:SUITE 1000
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-7402
Practice Address - Country:US
Practice Address - Phone:920-739-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16358-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist