Provider Demographics
NPI:1497826457
Name:MIKLAVCIC, KATHRYN RUTH (RPH)
Entity type:Individual
Prefix:MISS
First Name:KATHRYN
Middle Name:RUTH
Last Name:MIKLAVCIC
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4674 MALLARD POND DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-1672
Mailing Address - Country:US
Mailing Address - Phone:440-465-4409
Mailing Address - Fax:
Practice Address - Street 1:24865 EMERY RD
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5636
Practice Address - Country:US
Practice Address - Phone:216-755-5391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5482133V00000X
OH03334649183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered