Healthcare Provider Details

I. General information

NPI: 1497826457
Provider Name (Legal Business Name): KATHRYN RUTH MIKLAVCIC RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24865 EMERY RD
WARRENSVILLE HEIGHTS OH
44128-5636
US

IV. Provider business mailing address

4674 MALLARD POND DR
AKRON OH
44333-1672
US

V. Phone/Fax

Practice location:
  • Phone: 216-755-5391
  • Fax:
Mailing address:
  • Phone: 440-465-4409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number5482
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03334649
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: