Provider Demographics
NPI:1760639751
Name:ZUPANCIC, KEVIN RICHARD (PHARMD, RPH)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:RICHARD
Last Name:ZUPANCIC
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7007 POWERS BLVD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5437
Mailing Address - Country:US
Mailing Address - Phone:440-743-4032
Mailing Address - Fax:440-743-4326
Practice Address - Street 1:7007 POWERS BLVD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5437
Practice Address - Country:US
Practice Address - Phone:440-743-4032
Practice Address - Fax:440-743-4326
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-18235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist