Provider Demographics
NPI:1194099846
Name:KAVANAUGH, RACHEL (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:KAVANAUGH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MRS
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:RYPEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:257 S BROOKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-6150
Mailing Address - Country:US
Mailing Address - Phone:608-575-5787
Mailing Address - Fax:
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-8289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-28
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16442-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist