Provider Demographics
NPI:1891372728
Name:VAZQUEZ, RACHEL DANIELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:DANIELLE
Last Name:VAZQUEZ
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 1:45 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3034
Mailing Address - Country:US
Mailing Address - Phone:978-835-2763
Mailing Address - Fax:
Practice Address - Street 1:440 PAYNE RD
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8928
Practice Address - Country:US
Practice Address - Phone:207-883-3617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR70254183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist