Provider Demographics
NPI:1871873513
Name:DIETZ, RACHEL RODELL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:RODELL
Last Name:DIETZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:RODELL
Other - Last Name:DIETZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1400 MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-2449
Mailing Address - Country:US
Mailing Address - Phone:937-492-5340
Mailing Address - Fax:937-493-0491
Practice Address - Street 1:1400 MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-2449
Practice Address - Country:US
Practice Address - Phone:937-492-5340
Practice Address - Fax:937-493-0491
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03129389183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist