Provider Demographics
NPI:1669749800
Name:THERMORA, RACHELLE ALESSANDRA (PHARM D)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:ALESSANDRA
Last Name:THERMORA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 E SPRING ST
Mailing Address - Street 2:APT 3
Mailing Address - City:AVON
Mailing Address - State:MA
Mailing Address - Zip Code:02322-1901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 PLEASANT STREET
Practice Address - Street 2:WALGREENS PHARMACY
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:508-427-6223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233707183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist