Healthcare Provider Details

I. General information

NPI: 1750070025
Provider Name (Legal Business Name): KENNETH PRAYZER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3402 CLARK AVE
CLEVELAND OH
44109-1136
US

IV. Provider business mailing address

33310 BELLADON CT
AVON LAKE OH
44012-2659
US

V. Phone/Fax

Practice location:
  • Phone: 216-961-9414
  • Fax:
Mailing address:
  • Phone: 480-540-4035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03215251
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: