Healthcare Provider Details

I. General information

NPI: 1164957312
Provider Name (Legal Business Name): KRISTIN KASPERCZYK PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 OAK HARBOR RD
FREMONT OH
43420-1023
US

IV. Provider business mailing address

4504 E LAUREL RIDGE DR
PORT CLINTON OH
43452-4005
US

V. Phone/Fax

Practice location:
  • Phone: 419-332-9187
  • Fax:
Mailing address:
  • Phone: 330-844-2587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03331443
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03331443
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: