MEDICARE: KET MEDS INC.

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	02-0943900	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3658018	OTHER	OH	NCPDP #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053353425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KET MEDS INC.

Provider Business Mailing Address
First Line	:	2419 FAR HILLS AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45419-1502
Country	:	US
Telephone Number	:	937-293-3172
Fax Number	:	937-293-8539

Provider Business Practice Location Address
First Line	:	2419 FAR HILLS AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45419-1502
Country	:	US
Telephone Number	:	937-293-3172
Fax Number	:	937-293-8539

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. DEBORAH LYNN COX
Credential	:
Telephone Number	:	937-293-3172

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	03/07/2023

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Directions to “KET MEDS INC. ” Practice Location

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