Healthcare Provider Details

I. General information

NPI: 1679244420
Provider Name (Legal Business Name): YUKIMI ANN VICCARO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5321 WARRENSVILLE CENTER RD
MAPLE HEIGHTS OH
44137-1908
US

IV. Provider business mailing address

5321 WARRENSVILLE CENTER RD
MAPLE HEIGHTS OH
44137-1908
US

V. Phone/Fax

Practice location:
  • Phone: 216-332-9592
  • Fax: 216-332-9615
Mailing address:
  • Phone: 216-332-9592
  • Fax: 216-332-9615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0320146
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: