MEDICARE: MRS. KAROL KIRK R.PH.

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	1835G0303X	Geriatric Pharmacist		OH

General Provider Information

NPI Number	:	1629259619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAROL KIRK R.PH.

Provider Business Mailing Address
First Line	:	2160 PLYMOUTH LN
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44221-3664
Country	:	US
Telephone Number	:	330-922-3470
Fax Number	:	330-926-1139

Provider Business Practice Location Address
First Line	:	2160 PLYMOUTH LN
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44221-3664
Country	:	US
Telephone Number	:	330-922-3470
Fax Number	:	330-926-1139

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

Provider Enumeration Date	:	11/18/2007
Last Update Date	:	11/18/2007

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