Healthcare Provider Details

I. General information

NPI: 1518016021
Provider Name (Legal Business Name): KAUP PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E BUTLER ST SUITE B
FORT RECOVERY OH
45846-0605
US

IV. Provider business mailing address

110 E BUTLER ST SUITE B
FORT RECOVERY OH
45846-0605
US

V. Phone/Fax

Practice location:
  • Phone: 419-375-2323
  • Fax: 419-375-5500
Mailing address:
  • Phone: 419-375-2323
  • Fax: 419-375-5500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number02 1256100
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number02 1256100
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number02 1256100
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JASON C ANDREWS
Title or Position: PRESIDENT
Credential:
Phone: 419-375-2323