Provider Demographics
NPI:1285347823
Name:BLYTHE, RACHEL ANNE (PHARMD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANNE
Last Name:BLYTHE
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 1:4251 COMMONS DR W UNIT 5215
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-8636
Mailing Address - Country:US
Mailing Address - Phone:817-455-7273
Mailing Address - Fax:
Practice Address - Street 1:99 EGLIN PKWY
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4956
Practice Address - Country:US
Practice Address - Phone:850-244-1226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS65269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist