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General NPI Number Information
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NPI Number | 1710457734
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Entity Type | Individual
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Provider Name | ANGELA MICHELLE RAUCH
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Gender | Female
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Dates
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Enumeration Date | 12/03/2018
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Last Update Date | 12/03/2018
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Provider Practice Location Address
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Address Line | 1440 ALLEGHENY ST
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City | JERSEY SHORE
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State | PA
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Zip | 17740-1116
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Country | US
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Telephone | 570-398-7757
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Fax | 570-398-4694
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Provider Business Mailing Address
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Address Line | 114 SKUNK HOLLOW RD
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City | NORTH BEND
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State | PA
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Zip | 17760-9548
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Country | US
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Telephone | 570-660-1625
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP040252L
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License Number State | PA
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