MEDICARE: KENNETH WILLINGER

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	03333425	OH

General Provider Information

NPI Number	:	1568978732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH WILLINGER

Provider Business Mailing Address
First Line	:	5334 STURBRIDGE CT
Second Line	:
City	:	SHEFFIELD VILLAGE
State	:	OH
Zip	:	44054-2967
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4106 E LAKE RD
Second Line	:
City	:	SHEFFIELD LAKE
State	:	OH
Zip	:	44054-1114
Country	:	US
Telephone Number	:	440-949-6239
Fax Number	:

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

Provider Enumeration Date	:	12/23/2017
Last Update Date	:	12/23/2017

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