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NPI Code Detail

MEDICARE: MRS. CARLOTTA CHAYA HENRIQUEZ-SMITH RPH

MEDICARE: MRS. CARLOTTA CHAYA HENRIQUEZ-SMITH 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
1183500000XPharmacist03132091OH

General Provider Information

NPI Number : 1508114588
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CARLOTTA CHAYA HENRIQUEZ-SMITH RPH
Provider Business Mailing Address
First Line : 3402 CLARK AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44109-1136
Country : US
Telephone Number : 216-961-9414
Fax Number : 216-651-8205
Provider Business Practice Location Address
First Line : 3402 CLARK AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44109-1136
Country : US
Telephone Number : 216-961-9414
Fax Number : 216-651-8205
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2012
Last Update Date : 08/22/2012

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