Provider Demographics
NPI:1932476579
Name:CARRASCA, RACHAEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:CARRASCA
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 1:5001 N BIG HOLLOW RD STE 7
Mailing Address - Street 2:0871
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-3546
Mailing Address - Country:US
Mailing Address - Phone:309-691-9310
Mailing Address - Fax:
Practice Address - Street 1:5001 N BIG HOLLOW RD STE 7
Practice Address - Street 2:0871
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-3546
Practice Address - Country:US
Practice Address - Phone:309-691-9310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051292112183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist