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NPI Code Detail

MEDICARE: RAYCHELLE IVIE CPHT

MEDICARE: RAYCHELLE IVIE CPHT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183700000XPharmacy TechnicianT45310AL

General Provider Information

NPI Number : 1932700689
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAYCHELLE IVIE CPHT
Provider Business Mailing Address
First Line : 3611 RICE MINE RD NE LOT 209
Second Line :
City : TUSCALOOSA
State : AL
Zip : 35406-1551
Country : US
Telephone Number : 205-219-4561
Fax Number :
Provider Business Practice Location Address
First Line : 4373 NORTHCREEK BLVD
Second Line :
City : NORTHPORT
State : AL
Zip : 35473-2171
Country : US
Telephone Number : 800-489-3636
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2020
Last Update Date : 11/07/2020

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