Provider Demographics
NPI:1659471654
Name:KLEINS PHARMACY & ORTHOPEDIC APPLIANCES INC AND SUBSIDIARY
Entity Type:Organization
Organization Name:KLEINS PHARMACY & ORTHOPEDIC APPLIANCES INC AND SUBSIDIARY
Other - Org Name:KLEINS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RPH
Authorized Official - Phone:330-928-3720
Mailing Address - Street 1:2015 STATE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1425
Mailing Address - Country:US
Mailing Address - Phone:330-928-3720
Mailing Address - Fax:330-940-4241
Practice Address - Street 1:2015 STATE RD
Practice Address - Street 2:SUITE A
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1425
Practice Address - Country:US
Practice Address - Phone:330-928-3720
Practice Address - Fax:330-940-4241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-00906003336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0011347Medicaid
OH0913160001Medicare ID - Type Unspecified
OH0913160001Medicare NSC