Provider Demographics
NPI:1811576747
Name:STEPHANI, RACHELLE (CPHT)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:STEPHANI
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 WOODBRIDGE ST APT 108
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-3827
Mailing Address - Country:US
Mailing Address - Phone:612-433-6858
Mailing Address - Fax:
Practice Address - Street 1:1512 WOODBRIDGE ST APT 108
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-3827
Practice Address - Country:US
Practice Address - Phone:612-433-6858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN723701183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician