Provider Demographics
NPI:1184632085
Name:NITKIEWICZ, CARLA ANN (RPH BS PHARM)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:ANN
Last Name:NITKIEWICZ
Suffix:
Gender:F
Credentials:RPH BS PHARM
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:ANN
Other - Last Name:ESHLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:420 BAY BREEZE DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-2981
Mailing Address - Country:US
Mailing Address - Phone:419-344-5573
Mailing Address - Fax:
Practice Address - Street 1:420 BAY BREEZE DR UNIT A
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-2981
Practice Address - Country:US
Practice Address - Phone:419-344-5573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442889183500000X
OH03221042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist