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General NPI Number Information
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NPI Number | 1245770312
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Entity Type | Individual
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Provider Name | DOUGLAS FIKE
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Gender | Male
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Dates
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Enumeration Date | 03/08/2017
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Last Update Date | 03/08/2017
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Provider Practice Location Address
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Address Line | 6835 BROADWAY AVE
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City | CLEVELAND
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State | OH
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Zip | 44105-1313
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Country | US
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Telephone | 216-957-1510
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Fax |
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Provider Business Mailing Address
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Address Line | 537 WILMINGTON DR
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City | BROADVIEW HTS
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State | OH
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Zip | 44147-4408
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Country | US
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Telephone | 216-407-9419
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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 | 03330969
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License Number State | OH
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