Provider Demographics
NPI:1083717102
Name:K-C HEALTH SERVICES INC
Entity Type:Organization
Organization Name:K-C HEALTH SERVICES INC
Other - Org Name:BREWSTER FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:CATHER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH MBA
Authorized Official - Phone:330-899-0406
Mailing Address - Street 1:360 WABASH AVE N
Mailing Address - Street 2:STE A
Mailing Address - City:BREWSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44613-1042
Mailing Address - Country:US
Mailing Address - Phone:330-767-3436
Mailing Address - Fax:330-767-3090
Practice Address - Street 1:360 WABASH AVE N
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:OH
Practice Address - Zip Code:44613-1042
Practice Address - Country:US
Practice Address - Phone:330-767-3436
Practice Address - Fax:330-767-3090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH0208312003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2073721OtherPK