Healthcare Provider Details

I. General information

NPI: 1538575634
Provider Name (Legal Business Name): DR. ADRIENNE MIELNIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5411 SUPERIOR AVE
CLEVELAND OH
44103-1344
US

IV. Provider business mailing address

1440 THATCHER DR
PAINESVILLE OH
44077-5002
US

V. Phone/Fax

Practice location:
  • Phone: 216-431-5643
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03330939
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: