Healthcare Provider Details

I. General information

NPI: 1265713044
Provider Name (Legal Business Name): RACHAEL LYNNE HUTCHINSON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DATES DR
ITHACA NY
14850-1342
US

IV. Provider business mailing address

101 DATES DR
ITHACA NY
14850-1342
US

V. Phone/Fax

Practice location:
  • Phone: 607-274-4392
  • Fax: 607-274-4534
Mailing address:
  • Phone: 607-274-4392
  • Fax: 607-274-4534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number047601
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: