Provider Demographics
NPI:1750982864
Name:STREET, RACHEL (PHARMD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:STREET
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 1:3207 LYNTZ TOWNLINE RD SW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44481-9282
Mailing Address - Country:US
Mailing Address - Phone:330-979-7212
Mailing Address - Fax:
Practice Address - Street 1:2016 MILLENNIUM BLVD
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-9173
Practice Address - Country:US
Practice Address - Phone:330-372-1992
Practice Address - Fax:330-372-9369
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03228193183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist