Healthcare Provider Details

I. General information

NPI: 1134122807
Provider Name (Legal Business Name): ALAN ROBERT KAZAN PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1464 E 105TH ST STE 201
CLEVELAND OH
44106-1100
US

IV. Provider business mailing address

8730 ARBORHURST LN
KIRTLAND OH
44094-9323
US

V. Phone/Fax

Practice location:
  • Phone: 216-721-5776
  • Fax: 216-721-5888
Mailing address:
  • Phone: 440-256-2695
  • Fax: 216-531-0877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number03-1-10973
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: