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General NPI Number Information
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NPI Number | 1235350794
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Entity Type | Individual
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Provider Name | MYRNA ELAINE SPIVACK RPH
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Gender | Female
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/30/2009
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Provider Practice Location Address
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Address Line | 6410 BROADWAY AVE
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City | CLEVELAND
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State | OH
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Zip | 44105-1253
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Country | US
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Telephone | 216-883-0183
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Fax |
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Provider Business Mailing Address
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Address Line | 6410 BROADWAY AVE
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City | CLEVELAND
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State | OH
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Zip | 44105-1253
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Country | US
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Telephone | 216-883-0183
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03-2-18213
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302023660
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License Number State | MI
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