Provider Demographics
NPI:1124619408
Name:WOLOVICH, RACHEL MARY (PHARMD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARY
Last Name:WOLOVICH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 ELDEN ST
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4511
Mailing Address - Country:US
Mailing Address - Phone:703-215-8000
Mailing Address - Fax:
Practice Address - Street 1:412 ELDEN ST
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4511
Practice Address - Country:US
Practice Address - Phone:703-215-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP439397183500000X
VA0202211312183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist