Provider Demographics
NPI:1841919628
Name:NOWAK, RACHEL CECELIA (PHARMD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:CECELIA
Last Name:NOWAK
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 1:309 FULTON ST E APT 6
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4354
Mailing Address - Country:US
Mailing Address - Phone:989-522-3279
Mailing Address - Fax:
Practice Address - Street 1:3610 PLAINFIELD AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-2402
Practice Address - Country:US
Practice Address - Phone:616-365-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5351011918183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist