Healthcare Provider Details

I. General information

NPI: 1902591662
Provider Name (Legal Business Name): AUSTIN ROFE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 04/10/2023
Certification Date: 04/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 EUCLID AVE
CLEVELAND OH
44103-3734
US

IV. Provider business mailing address

6413 ROSEBELLE AVE
NORTH RIDGEVILLE OH
44039-3041
US

V. Phone/Fax

Practice location:
  • Phone: 216-431-5800
  • Fax:
Mailing address:
  • Phone: 440-724-2113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number060000822
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: