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NPI Code Detail

MEDICARE: MRS. KATHLEEN J HISTED R.PH.

MEDICARE: MRS. KATHLEEN J HISTED R.PH.
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
1183500000XPharmacist03212539OH

General Provider Information

NPI Number : 1255611992
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATHLEEN J HISTED R.PH.
Provider Business Mailing Address
First Line : 588 COLEMAN RD
Second Line :
City : MANSFIELD
State : OH
Zip : 44903-1810
Country : US
Telephone Number : 419-522-5749
Fax Number :
Provider Business Practice Location Address
First Line : 1000 PARK AVE W
Second Line :
City : MANSFIELD
State : OH
Zip : 44906-2810
Country : US
Telephone Number : 419-529-3790
Fax Number : 419-529-4580
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2011
Last Update Date : 08/25/2011

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