Provider Demographics
NPI:1760471577
Name:KRATZER PHARMACY INC.
Entity Type:Organization
Organization Name:KRATZER PHARMACY INC.
Other - Org Name:KRATZER'S HOMETOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:KRATZER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:937-382-0081
Mailing Address - Street 1:179 W LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2180
Mailing Address - Country:US
Mailing Address - Phone:937-382-0081
Mailing Address - Fax:937-655-8774
Practice Address - Street 1:179 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2180
Practice Address - Country:US
Practice Address - Phone:937-382-0081
Practice Address - Fax:937-655-8774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021234150163WD0400X
332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH22248124Medicaid
OH22248124Medicaid