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NPI Code Detail

MEDICARE: DR. KRYSTAL ROSE RICCIARDELLA PHARMD

MEDICARE: DR. KRYSTAL ROSE RICCIARDELLA PHARMD
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
1183500000XPharmacist03230415OH
2183500000XPharmacist5302039429MI

General Provider Information

NPI Number : 1760768535
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRYSTAL ROSE RICCIARDELLA PHARMD
Provider Business Mailing Address
First Line : 1910 S REYNOLDS RD
Second Line :
City : TOLEDO
State : OH
Zip : 43614-1438
Country : US
Telephone Number : 419-867-3529
Fax Number :
Provider Business Practice Location Address
First Line : 1910 S REYNOLDS RD
Second Line :
City : TOLEDO
State : OH
Zip : 43614-1438
Country : US
Telephone Number : 419-867-3529
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2011
Last Update Date : 10/25/2011

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Directions to “ DR. KRYSTAL ROSE RICCIARDELLA PHARMD” Practice Location

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