Provider Demographics
NPI:1881954063
Name:MARQUEZ, RACHAEL NICOLE
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:NICOLE
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:NICOLE
Other - Last Name:WARDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:405 FLORIDA TRAIL
Mailing Address - Street 2:
Mailing Address - City:INTERLACHEN
Mailing Address - State:FL
Mailing Address - Zip Code:32148
Mailing Address - Country:US
Mailing Address - Phone:386-916-6038
Mailing Address - Fax:
Practice Address - Street 1:719 S STATE ROAD 19
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3946
Practice Address - Country:US
Practice Address - Phone:386-328-6787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT6978183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRPT6978OtherCERTIFIED PHARAMCY TECHINICIAN