MEDICARE: DKC SHOP INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386638336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DKC SHOP INC.

Provider Business Mailing Address
First Line	:	6313 VINE ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45216-2169
Country	:	US
Telephone Number	:	513-242-1123
Fax Number	:	513-242-6123

Provider Business Practice Location Address
First Line	:	6313 VINE ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45216-2169
Country	:	US
Telephone Number	:	513-242-1123
Fax Number	:	513-242-6123

Authorized Official
Title or Position	:	CEO
Name	:	MR. MARK ANTHONY FLOYD
Credential	:
Telephone Number	:	513-242-1123

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	08/22/2020

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Directions to “DKC SHOP INC. ” Practice Location

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