Healthcare Provider Details

I. General information

NPI: 1558730143
Provider Name (Legal Business Name): RAQUEL HERTIG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2015
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3259 CATLIN AVE
QUANTICO VA
22134-5109
US

IV. Provider business mailing address

54 COLEMANS MILL DR
FREDERICKSBURG VA
22405-2183
US

V. Phone/Fax

Practice location:
  • Phone: 703-784-1924
  • Fax:
Mailing address:
  • Phone: 253-736-3901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202220639
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25509
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: