Healthcare Provider Details

I. General information

NPI: 1053967364
Provider Name (Legal Business Name): KSAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2245 W DUBLIN GRANVILLE RD STE 103
WORTHINGTON OH
43085-3336
US

IV. Provider business mailing address

2245 W DUBLIN GRANVILLE RD STE 103
WORTHINGTON OH
43085-3336
US

V. Phone/Fax

Practice location:
  • Phone: 614-392-0960
  • Fax: 614-392-5657
Mailing address:
  • Phone: 614-392-0960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHAD THOMPSON
Title or Position: PHARMACIST
Credential: RPH
Phone: 614-392-0960