=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417935297
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KARL ROAD DRUGGIST LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2006
-----------------------------------------------------
Last Update Date | 03/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5770 KARL RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43229-3604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-847-3784
-----------------------------------------------------
Fax | 614-847-6171
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 126
-----------------------------------------------------
City | PLAIN CITY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43064-0126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-573-1557
-----------------------------------------------------
Fax | 614-300-7558
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | LONNIE CRAFT
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 614-573-1557
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | RTP02244525003
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------