MEDICARE: KAF PHARMACY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	P07534	KY

General Provider Information

NPI Number	:	1043555063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAF PHARMACY, LLC

Provider Business Mailing Address
First Line	:	126 E MAIN ST
Second Line	:
City	:	CARLISLE
State	:	KY
Zip	:	40311-1154
Country	:	US
Telephone Number	:	859-289-2246
Fax Number	:	859-289-2246

Provider Business Practice Location Address
First Line	:	126 E MAIN ST
Second Line	:
City	:	CARLISLE
State	:	KY
Zip	:	40311-1154
Country	:	US
Telephone Number	:	859-289-2246
Fax Number	:	859-289-2246

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KEVIN ANTHONY FOSSO
Credential	:	PHARM.D.
Telephone Number	:	859-523-0987

Provider Enumeration Date	:	12/02/2012
Last Update Date	:	12/02/2012

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