Healthcare Provider Details

I. General information

NPI: 1528643061
Provider Name (Legal Business Name): ANDREA MARIE KAIFESH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36212 EUCLID AVE
WILLOUGHBY OH
44094-4413
US

IV. Provider business mailing address

7787 ELLINGTON PL
MENTOR OH
44060-5300
US

V. Phone/Fax

Practice location:
  • Phone: 440-942-4288
  • Fax:
Mailing address:
  • Phone: 440-840-8556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03440452
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: