Provider Demographics
NPI:1164206702
Name:REVOCK, REBECCA (CPHT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:REVOCK
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:WEITZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8333 ROCKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44125-6134
Mailing Address - Country:US
Mailing Address - Phone:216-369-2200
Mailing Address - Fax:216-369-2201
Practice Address - Street 1:8333 ROCKSIDE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44125-6134
Practice Address - Country:US
Practice Address - Phone:216-369-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30062747183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH30062747OtherCPHT
OH444894OtherNABP