Healthcare Provider Details

I. General information

NPI: 1134940448
Provider Name (Legal Business Name): CHLOE BUKVICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2024
Last Update Date: 10/19/2024
Certification Date: 10/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 WARRENSVILLE CENTER RD STE 2392A
BEACHWOOD OH
44122-5203
US

IV. Provider business mailing address

1461 RYDALMOUNT RD
CLEVELAND HEIGHTS OH
44118-1347
US

V. Phone/Fax

Practice location:
  • Phone: 866-844-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03444928
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: