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General NPI Number Information
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NPI Number | 1386249704
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Entity Type | Individual
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Provider Name | COURTNEY NICOLE HOFSTETTER RPH
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Gender | Female
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Dates
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Enumeration Date | 12/02/2020
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Last Update Date | 12/02/2020
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Provider Practice Location Address
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Address Line | 1411 LEXINGTON AVE
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City | MANSFIELD
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State | OH
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Zip | 44907-2629
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Country | US
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Telephone | 419-756-1321
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Fax | 419-756-6632
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Provider Business Mailing Address
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Address Line | 3525 NEEDHAM RD
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City | LEXINGTON
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State | OH
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Zip | 44904-9216
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Country | US
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Telephone | 567-231-9561
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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 | 03127252
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License Number State | OH
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