Provider Demographics
NPI:1518016021
Name:KAUP PHARMACY, INC.
Entity Type:Organization
Organization Name:KAUP PHARMACY, INC.
Other - Org Name:KAUP PHARMACYDEPENDABLE HOME IV SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KAUP
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:419-375-2323
Mailing Address - Street 1:110 E BUTLER ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT RECOVERY
Mailing Address - State:OH
Mailing Address - Zip Code:45846-0605
Mailing Address - Country:US
Mailing Address - Phone:419-375-2323
Mailing Address - Fax:419-375-5500
Practice Address - Street 1:110 E BUTLER ST
Practice Address - Street 2:SUITE B
Practice Address - City:FORT RECOVERY
Practice Address - State:OH
Practice Address - Zip Code:45846-0605
Practice Address - Country:US
Practice Address - Phone:419-375-2323
Practice Address - Fax:419-375-5500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAUP PHARMACY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-10
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02 12561003336C0004X, 3336L0003X, 3336S0011X
3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000195955OtherANTHEM
IN201370590AMedicaid
OH0072652Medicaid
OH4121920001Medicare NSC
KY4121920001Medicare NSC