Healthcare Provider Details

I. General information

NPI: 1720529324
Provider Name (Legal Business Name): CHRIS RHODES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2017
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 CLEVELAND AVE NW STE 301
CANTON OH
44702-1805
US

IV. Provider business mailing address

625 CLEVELAND AVE NW STE 301
CANTON OH
44702-1805
US

V. Phone/Fax

Practice location:
  • Phone: 234-203-1825
  • Fax: 234-203-5006
Mailing address:
  • Phone: 234-203-1825
  • Fax: 234-203-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number25129
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: