Provider Demographics
NPI:1720160161
Name:HENEGAR, RACHEL LOUISE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:LOUISE
Last Name:HENEGAR
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 1:21834 TIFFANY DR
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1649
Mailing Address - Country:US
Mailing Address - Phone:734-671-1076
Mailing Address - Fax:734-676-5725
Practice Address - Street 1:3390 WEST RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2323
Practice Address - Country:US
Practice Address - Phone:734-676-6622
Practice Address - Fax:734-676-5725
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029023183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302029023OtherPHARMACIST LICENSE NUMBER