Provider Demographics
NPI:1801052345
Name:WENTWORTH, RACHAEL M (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:M
Last Name:WENTWORTH
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 1:14075 HWY 13 S
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-3100
Mailing Address - Country:US
Mailing Address - Phone:952-447-1611
Mailing Address - Fax:952-447-1619
Practice Address - Street 1:14075 HWY 13 S
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-3100
Practice Address - Country:US
Practice Address - Phone:952-447-1611
Practice Address - Fax:952-447-1619
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist