MEDICARE: MR. WADE A KIRK RPH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	251S00000X	Community/Behavioral Health Agency
3	183500000X	Pharmacist	03-3-20286	OH

General Provider Information

NPI Number	:	1215159892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WADE A KIRK RPH.

Provider Business Mailing Address
First Line	:	96 INTEGRITY DR STE D
Second Line	:
City	:	HEBRON
State	:	OH
Zip	:	43025-7013
Country	:	US
Telephone Number	:	740-928-3455
Fax Number	:

Provider Business Practice Location Address
First Line	:	96 INTEGRITY DR
Second Line	:
City	:	HEBRON
State	:	OH
Zip	:	43025-7013
Country	:	US
Telephone Number	:	740-928-3455
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	11/27/2023

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