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NPI Code Detail

MEDICARE: PAUL MICHAEL MORAVEC R.PH

MEDICARE: PAUL MICHAEL MORAVEC R.PH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist03-1-17539OH

General Provider Information

NPI Number : 1154597763
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL MICHAEL MORAVEC R.PH
Provider Business Mailing Address
First Line : 3402 CLARK AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44109-1136
Country : US
Telephone Number : 216-961-9414
Fax Number : 216-651-8205
Provider Business Practice Location Address
First Line : 3402 CLARK AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44109-1136
Country : US
Telephone Number : 216-961-9414
Fax Number : 216-651-8205
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2008
Last Update Date : 05/03/2008

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