Provider Demographics
NPI:1619972189
Name:KRATZER'S PHARMACY, INC.
Entity Type:Organization
Organization Name:KRATZER'S PHARMACY, INC.
Other - Org Name:KRATZER'S HOMETOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:KRATZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-783-5444
Mailing Address - Street 1:912 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:BLANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45107-1318
Mailing Address - Country:US
Mailing Address - Phone:937-783-5444
Mailing Address - Fax:937-783-5446
Practice Address - Street 1:912 CHERRY ST
Practice Address - Street 2:
Practice Address - City:BLANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45107-1318
Practice Address - Country:US
Practice Address - Phone:937-783-5444
Practice Address - Fax:937-783-5446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2496642Medicaid
OH4060010002Medicare ID - Type Unspecified