Healthcare Provider Details

I. General information

NPI: 1730324989
Provider Name (Legal Business Name): KELLY LEIGH MANOCCHIO RPH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 12/02/2008
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 DR
BROOKLYN HEIGHTS OH
44131-1832
US

V. Phone/Fax

Practice location:
  • Phone: 216-778-6050
  • Fax: 216-749-8426
Mailing address:
  • Phone: 216-778-6050
  • Fax: 216-749-8426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03219783
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26017041A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: