Provider Demographics
NPI:1760584296
Name:HORSTMAN, TRICIA KIRKENDALL (RPH)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:KIRKENDALL
Last Name:HORSTMAN
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 1:206 KENNEDY ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:OH
Mailing Address - Zip Code:45875-9409
Mailing Address - Country:US
Mailing Address - Phone:419-538-6533
Mailing Address - Fax:
Practice Address - Street 1:138 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEIPSIC
Practice Address - State:OH
Practice Address - Zip Code:45856-1427
Practice Address - Country:US
Practice Address - Phone:419-943-2561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-17014183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist