Provider Demographics
NPI:1891948998
Name:KAUP, GERALD MARK (RPH)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:MARK
Last Name:KAUP
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 LITTLE TURTLE DRIVE
Mailing Address - Street 2:PO BOX 605
Mailing Address - City:FORT RECOVERY
Mailing Address - State:OH
Mailing Address - Zip Code:45846-0605
Mailing Address - Country:US
Mailing Address - Phone:419-375-4552
Mailing Address - Fax:419-375-4488
Practice Address - Street 1:110 E BUTLER ST
Practice Address - Street 2:
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:419-375-4488
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03113595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist