Provider Demographics
NPI:1811079619
Name:KAUP PHARMACY, INC.
Entity type:Organization
Organization Name:KAUP PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-375-7007
Mailing Address - Street 1:PO BOX 605
Mailing Address - Street 2:
Mailing Address - City:FORT RECOVERY
Mailing Address - State:OH
Mailing Address - Zip Code:45846-0605
Mailing Address - Country:US
Mailing Address - Phone:419-375-7007
Mailing Address - Fax:419-375-9104
Practice Address - Street 1:1201 COMMERCE STREET
Practice Address - Street 2:
Practice Address - City:FT. RECOVERY
Practice Address - State:OH
Practice Address - Zip Code:45846
Practice Address - Country:US
Practice Address - Phone:419-375-7007
Practice Address - Fax:419-375-9104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH54013006332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2891330Medicaid
OH0439243Medicaid
IN200461790AMedicaid
OH2891330Medicaid