Provider Demographics
NPI:1851715155
Name:CUNDIFF, RACHEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:CUNDIFF
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 UNION ST
Mailing Address - Street 2:
Mailing Address - City:LAKE STATION
Mailing Address - State:IN
Mailing Address - Zip Code:46405-1218
Mailing Address - Country:US
Mailing Address - Phone:219-962-4470
Mailing Address - Fax:
Practice Address - Street 1:52482 SR 933 N
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46637
Practice Address - Country:US
Practice Address - Phone:574-271-0357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023627A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist