Healthcare Provider Details

I. General information

NPI: 1073065801
Provider Name (Legal Business Name): RACHAEL OYEWOLE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CORNER OF ROUTES 12 & 7
FORT DEFIANCE AZ
86504
US

IV. Provider business mailing address

PO BOX 3402
FORT DEFIANCE AZ
86504-3402
US

V. Phone/Fax

Practice location:
  • Phone: 928-729-8328
  • Fax: 928-729-8348
Mailing address:
  • Phone: 928-729-8328
  • Fax: 928-729-8348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24291
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: