Healthcare Provider Details

I. General information

NPI: 1790428282
Provider Name (Legal Business Name): ALEXIS GIRVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

9336 YORKSHIRE DR
SALINE MI
48176-9443
US

V. Phone/Fax

Practice location:
  • Phone: 734-308-5727
  • Fax:
Mailing address:
  • Phone: 734-308-5727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03439920
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number3165858
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: