Healthcare Provider Details

I. General information

NPI: 1760584296
Provider Name (Legal Business Name): TRICIA KIRKENDALL HORSTMAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 E MAIN ST
LEIPSIC OH
45856-1427
US

IV. Provider business mailing address

206 KENNEDY ST
OTTAWA OH
45875-9409
US

V. Phone/Fax

Practice location:
  • Phone: 419-943-2561
  • Fax:
Mailing address:
  • Phone: 419-538-6533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-3-17014
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: