Provider Demographics
NPI:1356936348
Name:RAKESTRAW, JEANNE DONNETTE (RPH)
Entity type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:DONNETTE
Last Name:RAKESTRAW
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1781 COUNTY ROAD 1669
Mailing Address - Street 2:
Mailing Address - City:HOLLY POND
Mailing Address - State:AL
Mailing Address - Zip Code:35083-6229
Mailing Address - Country:US
Mailing Address - Phone:256-962-2742
Mailing Address - Fax:
Practice Address - Street 1:1407 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-5310
Practice Address - Country:US
Practice Address - Phone:256-962-4251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12453183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist