Provider Demographics
NPI:1508977976
Name:NIETERT, KRIS (RPH)
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:
Last Name:NIETERT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19999 ROCKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-2074
Mailing Address - Country:US
Mailing Address - Phone:440-439-6622
Mailing Address - Fax:440-786-3843
Practice Address - Street 1:19999 ROCKSIDE RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2074
Practice Address - Country:US
Practice Address - Phone:440-439-6622
Practice Address - Fax:440-786-3843
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-16687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist