MEDICARE: MISS KATHRYN RUTH MIKLAVCIC 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	133V00000X	Registered Dietitian	5482	OH
2	183500000X	Pharmacist	03334649	OH

General Provider Information

NPI Number	:	1497826457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KATHRYN RUTH MIKLAVCIC RPH

Provider Business Mailing Address
First Line	:	4674 MALLARD POND DR
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44333-1672
Country	:	US
Telephone Number	:	440-465-4409
Fax Number	:

Provider Business Practice Location Address
First Line	:	24865 EMERY RD
Second Line	:
City	:	WARRENSVILLE HEIGHTS
State	:	OH
Zip	:	44128-5636
Country	:	US
Telephone Number	:	216-755-5391
Fax Number	:

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	06/25/2021

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