Provider Demographics
NPI:1295729044
Name:ROUSH, RACHELLE LYNN (RPH)
Entity type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:LYNN
Last Name:ROUSH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7038 GRASS RD
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-8723
Mailing Address - Country:US
Mailing Address - Phone:734-944-0114
Mailing Address - Fax:
Practice Address - Street 1:5333 MCAULEY DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1014
Practice Address - Country:US
Practice Address - Phone:734-712-2222
Practice Address - Fax:734-712-2189
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032819183500000X
IN26018029A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist