Healthcare Provider Details

I. General information

NPI: 1417779547
Provider Name (Legal Business Name): RACHAEL MARIE MAPLES CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10506 HUNTER TRACE DR
SODDY DAISY TN
37379-3579
US

IV. Provider business mailing address

4062 HIXSON PIKE
CHATTANOOGA TN
37415-3110
US

V. Phone/Fax

Practice location:
  • Phone: 423-358-7294
  • Fax:
Mailing address:
  • Phone: 423-877-3568
  • Fax: 423-803-4791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number30248387
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: