Provider Demographics
NPI:1437300217
Name:KAUP PHARMACY INC
Entity Type:Organization
Organization Name:KAUP PHARMACY INC
Other - Org Name:KAUP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, SEC, TREAS
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-302-1799
Mailing Address - Street 1:605 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ARCANUM
Mailing Address - State:OH
Mailing Address - Zip Code:45304-1401
Mailing Address - Country:US
Mailing Address - Phone:937-692-5406
Mailing Address - Fax:937-692-5129
Practice Address - Street 1:605 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ARCANUM
Practice Address - State:OH
Practice Address - Zip Code:45304-1401
Practice Address - Country:US
Practice Address - Phone:937-692-5406
Practice Address - Fax:937-692-5129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336S0011X
OH0219024503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2891321Medicaid
2117364OtherPK
OH2891321Medicaid