Healthcare Provider Details

I. General information

NPI: 1699127357
Provider Name (Legal Business Name): KAISER COMMUNITY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 BENEDICT AVE
NORWALK OH
44857-2346
US

IV. Provider business mailing address

251 BENEDICT AVE
NORWALK OH
44857-2346
US

V. Phone/Fax

Practice location:
  • Phone: 419-668-1078
  • Fax: 419-663-5837
Mailing address:
  • Phone: 419-668-1078
  • Fax: 419-663-5837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPMY.022651150-03
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GEORGE ELMER
Title or Position: VP
Credential:
Phone: 419-668-8101