Healthcare Provider Details

I. General information

NPI: 1225462708
Provider Name (Legal Business Name): RACHEL CIARAMELLO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 E BELTLINE AVE NE
GRAND RAPIDS MI
49525-1006
US

IV. Provider business mailing address

5100 E BELTLINE AVENUE NE
GRAND RAPIDS MI
49525
US

V. Phone/Fax

Practice location:
  • Phone: 616-361-1758
  • Fax:
Mailing address:
  • Phone: 616-361-8852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302040655
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: