Healthcare Provider Details

I. General information

NPI: 1780373423
Provider Name (Legal Business Name): KARA A KRSAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 05/08/2023
Certification Date: 05/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 NORTH PLAINS ROAD
THE PLAINS OH
45780
US

IV. Provider business mailing address

93 NORTH PLAINS ROAD
THE PLAINS OH
45780
US

V. Phone/Fax

Practice location:
  • Phone: 740-797-2546
  • Fax:
Mailing address:
  • Phone: 740-797-2546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number09118280
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: