Healthcare Provider Details

I. General information

NPI: 1790949089
Provider Name (Legal Business Name): DR. RACHEL NICOLE KOWALSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9505 VAUGHN RD
PIKE ROAD AL
36064-2292
US

IV. Provider business mailing address

4551 US HIGHWAY 80 W
TUSKEGEE AL
36083-5428
US

V. Phone/Fax

Practice location:
  • Phone: 334-277-1153
  • Fax:
Mailing address:
  • Phone: 334-725-9102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14873
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: