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NPI Code Detail

MEDICARE: MR. REX A. SPEERHAS R.PH., CDE, BCNSP

MEDICARE: MR. REX A. SPEERHAS R.PH., CDE, BCNSP
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
11835N1003XNutrition Support Pharmacist03-1-10964OH

General Provider Information

NPI Number : 1700888096
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. REX A. SPEERHAS R.PH., CDE, BCNSP
Provider Business Mailing Address
First Line : 2100 BERKELEY DR
Second Line :
City : WESTLAKE
State : OH
Zip : 44145-3220
Country : US
Telephone Number : 216-444-6315
Fax Number : 216-444-4380
Provider Business Practice Location Address
First Line : DEPARTMENT OF PHARMACY, QQB5
Second Line : 9500 EUCLID AVENUE
City : CLEVELAND
State : OH
Zip : 44195
Country : US
Telephone Number : 216-444-6315
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 07/08/2007

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