Provider Demographics
NPI:1750485710
Name:K-C HEALTH SERVICES INC
Entity Type:Organization
Organization Name:K-C HEALTH SERVICES INC
Other - Org Name:COMPOUNDING PHARMACY OF GREEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:CATHER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH MBA FASCP
Authorized Official - Phone:330-899-0406
Mailing Address - Street 1:4016 MASSILLON RD
Mailing Address - Street 2:STE B
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7818
Mailing Address - Country:US
Mailing Address - Phone:330-899-0406
Mailing Address - Fax:330-899-0652
Practice Address - Street 1:4016 MASSILLON RD
Practice Address - Street 2:STE B
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-7818
Practice Address - Country:US
Practice Address - Phone:330-899-0406
Practice Address - Fax:330-899-0652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
OH0214456503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2079958OtherPK