Provider Demographics
NPI:1174055768
Name:DEFFENBAUGH, RACHAEL LYNN (PHARMD)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:LYNN
Last Name:DEFFENBAUGH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:LYNN
Other - Last Name:WINTERMUTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:208-625-5688
Mailing Address - Fax:
Practice Address - Street 1:700 W IRONWOOD DR STE 246
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4473
Practice Address - Country:US
Practice Address - Phone:208-625-5688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-01
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP9753183500000X
WAPH60751105183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist