Provider Demographics
NPI:1760063010
Name:GEIDEMAN, NANCY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
Last Name:GEIDEMAN
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 1:28009 WOLF RD
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-2028
Mailing Address - Country:US
Mailing Address - Phone:440-537-3736
Mailing Address - Fax:
Practice Address - Street 1:27264 LORAIN RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-4032
Practice Address - Country:US
Practice Address - Phone:440-777-6148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-15862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist