Healthcare Provider Details

I. General information

NPI: 1154973683
Provider Name (Legal Business Name): NICOLE RENE KIRKLAND PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 E 185TH ST
EUCLID OH
44119-1355
US

IV. Provider business mailing address

26151 LAKE SHORE BLVD APT 1514
EUCLID OH
44132-1157
US

V. Phone/Fax

Practice location:
  • Phone: 216-383-7600
  • Fax:
Mailing address:
  • Phone: 724-877-9661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03438769
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: