Healthcare Provider Details

I. General information

NPI: 1164067005
Provider Name (Legal Business Name): DANA MICHALEK RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 W MAIN ST
LOUISVILLE OH
44641-1335
US

IV. Provider business mailing address

1315 S MARION AVE
LOUISVILLE OH
44641-2559
US

V. Phone/Fax

Practice location:
  • Phone: 330-875-1429
  • Fax:
Mailing address:
  • Phone: 330-323-0406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03120607
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: