MEDICARE: KELLIE ANN WERSC HEY 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	183500000X	Pharmacist	03-2-24781	OH

General Provider Information

NPI Number	:	1477548907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLIE ANN WERSC HEY RPH

Provider Business Mailing Address
First Line	:	4142 BRIDGEWATER PKWY
Second Line	:	APT. 101
City	:	STOW
State	:	OH
Zip	:	44224-6106
Country	:	US
Telephone Number	:	216-694-4629
Fax Number	:

Provider Business Practice Location Address
First Line	:	2351 E 22ND ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-3111
Country	:	US
Telephone Number	:	216-694-4629
Fax Number	:

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	07/08/2007

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