Provider Demographics
NPI:1891040010
Name:ALICEA, KRISTOPHER JOHN (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:JOHN
Last Name:ALICEA
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 1:910 SHARONDALE DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-1142
Mailing Address - Country:US
Mailing Address - Phone:440-309-8185
Mailing Address - Fax:
Practice Address - Street 1:5411 LEAVITT RD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-2155
Practice Address - Country:US
Practice Address - Phone:440-960-7225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-14
Last Update Date:2012-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03228308-2183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist