Healthcare Provider Details

I. General information

NPI: 1699407882
Provider Name (Legal Business Name): RACHEL KUO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST STE 5B
DETROIT MI
48201-2153
US

IV. Provider business mailing address

8378 REDWOOD TRL
DEXTER MI
48130-9103
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-1742
  • Fax:
Mailing address:
  • Phone: 734-972-5813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number5302413602
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: