Provider Demographics
NPI:1770266397
Name:LARGE, RACHEL THORNTON
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:THORNTON
Last Name:LARGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 174
Mailing Address - Street 2:
Mailing Address - City:WACHAPREAGUE
Mailing Address - State:VA
Mailing Address - Zip Code:23480-0174
Mailing Address - Country:US
Mailing Address - Phone:757-709-9796
Mailing Address - Fax:
Practice Address - Street 1:7001 LANKFORD HWY
Practice Address - Street 2:
Practice Address - City:OAK HALL
Practice Address - State:VA
Practice Address - Zip Code:23416-2223
Practice Address - Country:US
Practice Address - Phone:757-824-4477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202221472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist