Provider Demographics
NPI:1598135014
Name:FOX, C. RACHELE
Entity type:Individual
Prefix:
First Name:C. RACHELE
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:RACHELE
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1500 MUSEUM RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4761
Mailing Address - Country:US
Mailing Address - Phone:501-932-9010
Mailing Address - Fax:
Practice Address - Street 1:1500 MUSEUM RD STE 100
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4761
Practice Address - Country:US
Practice Address - Phone:501-932-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-26
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38683183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX38683OtherTEXAS STATE BOARD OF PHARMACY
ARPD08209OtherARKANSAS STATE BOARD OF PHARMACY