Healthcare Provider Details

I. General information

NPI: 1386632107
Provider Name (Legal Business Name): DEBORAH K WYLER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH K GROSS RPH

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 MEDINA RD SUITE 700 HARVEST GROVE PHARMACY
MEDINA OH
44256-0335
US

IV. Provider business mailing address

10 SHERWOOD COURT
BEACHWOOD OH
44122-7592
US

V. Phone/Fax

Practice location:
  • Phone: 888-322-6216
  • Fax: 800-258-9178
Mailing address:
  • Phone: 216-952-9278
  • Fax: 216-342-5642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number03-2-15438
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-2-15438
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: