MEDICARE: ERIN REISSIG

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	03122795	OH

General Provider Information

NPI Number	:	1811264443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN REISSIG

Provider Business Mailing Address
First Line	:	9961 SPEARHEAD DR
Second Line	:
City	:	BRECKSVILLE
State	:	OH
Zip	:	44141-3154
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12777 ROCKSIDE RD
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-4526
Country	:	US
Telephone Number	:	216-587-2943
Fax Number	:

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

Provider Enumeration Date	:	11/28/2011
Last Update Date	:	11/28/2011

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