MEDICARE: DR. KEVIN SECREST PHARM. D, 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	183500000X	Pharmacist	03-3-26636	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861443954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN SECREST PHARM. D, R.PH

Provider Business Mailing Address
First Line	:	688 PRAIRIE ROSE DR
Second Line	:
City	:	PERRYSBURG
State	:	OH
Zip	:	43551-5720
Country	:	US
Telephone Number	:	419-531-2836
Fax Number	:	419-531-7085

Provider Business Practice Location Address
First Line	:	3340 DORR ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-2717
Country	:	US
Telephone Number	:	419-531-2836
Fax Number	:	419-531-7085

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

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	11/05/2025

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