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General NPI Number Information
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NPI Number | 1609239136
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Entity Type | Organization
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Legal Business Name | KMART
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Dates
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Enumeration Date | 04/01/2016
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Last Update Date | 04/01/2016
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Provider Practice Location Address
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Address Line | 1801 W ALEXIS RD
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City | TOLEDO
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State | OH
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Zip | 43613-2302
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Country | US
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Telephone | 419-473-0206
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Fax | 419-473-3306
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Provider Business Mailing Address
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Address Line | 1801 W ALEXIS RD
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City | TOLEDO
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State | OH
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Zip | 43613-2302
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Country | US
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Telephone | 419-473-0206
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. ANDREW BERNARD HEUER
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Credential | R.PH.
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Telephone | 419-473-0206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03109283
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License Number State | OH
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