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General NPI Number Information
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NPI Number | 1760155642
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Entity Type | Individual
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Provider Name | NANCY SEVERT RPH
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Gender | Female
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Dates
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Enumeration Date | 07/27/2021
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Last Update Date | 07/27/2021
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Provider Practice Location Address
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Address Line | 183 E DAYTON YELLOW SPRINGS RD
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City | FAIRBORN
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State | OH
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Zip | 45324-3465
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Country | US
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Telephone | 937-878-2889
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Fax |
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Provider Business Mailing Address
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Address Line | 455 N KING ST
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City | XENIA
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State | OH
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Zip | 45385-2207
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Country | US
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Telephone | 937-371-8035
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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 | 03-2-21379
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License Number State | OH
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