MEDICARE: MARIE-ROSINE KAGABO

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	183500000X	Pharmacist	03334872	OH

General Provider Information

NPI Number	:	1316492374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE-ROSINE KAGABO

Provider Business Mailing Address
First Line	:	3020 MAYFIELD RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1702
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3020 MAYFIELD RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1702
Country	:	US
Telephone Number	:	216-932-4759
Fax Number	:

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

Provider Enumeration Date	:	08/19/2016
Last Update Date	:	08/19/2016

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Directions to “ MARIE-ROSINE KAGABO ” Practice Location

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