Provider Demographics
NPI:1417935297
Name:KARL ROAD DRUGGIST LLC
Entity Type:Organization
Organization Name:KARL ROAD DRUGGIST LLC
Other - Org Name:HAPPY DRUGGIST PHARMACY-KRD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:614-573-1557
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-0126
Mailing Address - Country:US
Mailing Address - Phone:614-573-1557
Mailing Address - Fax:614-300-7558
Practice Address - Street 1:5770 KARL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3604
Practice Address - Country:US
Practice Address - Phone:614-847-3784
Practice Address - Fax:614-847-6171
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OHIO APOTHECARIES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-03
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OHRTP022445250033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
H316790OtherPART B VACCINE PTAN
2149127OtherPK
OH0109764Medicaid