Provider Demographics
NPI:1649635160
Name:KAYWES INC
Entity type:Organization
Organization Name:KAYWES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER - RPH
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:KLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-924-2444
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:WEST UNITY
Mailing Address - State:OH
Mailing Address - Zip Code:43570-0265
Mailing Address - Country:US
Mailing Address - Phone:419-924-2444
Mailing Address - Fax:419-924-5903
Practice Address - Street 1:1260 S DEFIANCE ST
Practice Address - Street 2:
Practice Address - City:ARCHBOLD
Practice Address - State:OH
Practice Address - Zip Code:43502-1620
Practice Address - Country:US
Practice Address - Phone:567-444-4898
Practice Address - Fax:567-444-4899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OHPMY.022549300-033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2156183OtherPK
OH0156434Medicaid
OH0156434Medicaid