Healthcare Provider Details

I. General information

NPI: 1790754653
Provider Name (Legal Business Name): KLASS APOTHECARY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 12/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 E MAIN ST
OTTAWA OH
45875-1649
US

IV. Provider business mailing address

1831 E MAIN ST
OTTAWA OH
45875-1649
US

V. Phone/Fax

Practice location:
  • Phone: 419-523-6122
  • Fax: 419-523-6228
Mailing address:
  • Phone: 419-523-6122
  • Fax: 419-523-6228

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 Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number021756100
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROY KLASS
Title or Position: OWNER,PIC,AO
Credential: BS,RPH
Phone: 937-477-9653