Healthcare Provider Details

I. General information

NPI: 1083648760
Provider Name (Legal Business Name): KATHLEEN A NEUGEBAUER R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5420 LANCASTER DR
BROOKLYN HEIGHTS OH
44131-1832
US

IV. Provider business mailing address

5420 LANCASTER DRIVE
BROOKLYN HEIGHTS OH
44131
US

V. Phone/Fax

Practice location:
  • Phone: 216-635-4493
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-2-12524
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: