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General NPI Number Information
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NPI Number | 1417926262
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Entity Type | Organization
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Legal Business Name | KLASS APOTHECARY INC
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Dates
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Enumeration Date | 03/15/2006
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Last Update Date | 02/11/2011
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Provider Practice Location Address
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Address Line | 105 DR THATYE DRIVE
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City | GLANDORF
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State | OH
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Zip | 45848
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Country | US
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Telephone | 419-538-7120
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Fax | 419-538-7121
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Provider Business Mailing Address
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Address Line | PO BOX 33
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City | GLANDORF
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State | OH
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Zip | 45848-0033
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Country | US
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Telephone | 419-538-7120
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Fax | 419-538-7121
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Authorized Official
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Title or Position | OWNER
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Name | ROY KLASS
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Credential | BS RPH
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Telephone | 937-477-9653
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 021756150
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License Number State | OH
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