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General NPI Number Information
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NPI Number | 1609288976
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Entity Type | Organization
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Legal Business Name | CRP PHARMACY LLC
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Dates
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Enumeration Date | 05/21/2014
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Last Update Date | 08/15/2014
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Provider Practice Location Address
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Address Line | 10567 SAINT CLAIR AVE
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City | CLEVELAND
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State | OH
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Zip | 44108-1973
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Country | US
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Telephone | 855-856-9582
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Fax |
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Provider Business Mailing Address
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Address Line | 10567 ST. CLAIR AVE
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City | CLEVELAND
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State | OH
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Zip | 44108
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GUENET INDALE
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Credential | PHD
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Telephone | 216-288-5992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 022392900
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License Number State | OH
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