Provider Demographics
NPI:1750980751
Name:DIVINCENZO, RACHEL (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:DIVINCENZO
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4368 N MALLARD CV
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-9039
Mailing Address - Country:US
Mailing Address - Phone:859-992-6372
Mailing Address - Fax:
Practice Address - Street 1:11300 CORNELL PARK DR
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-1814
Practice Address - Country:US
Practice Address - Phone:513-387-1484
Practice Address - Fax:513-387-1470
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00151511835P0018X
KY0151081835P0018X
AZS0217481835P0018X
OH032305291835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist