MEDICARE: MR. MICHAEL E KACSMAR RPH

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	183500000X	Pharmacist	03-3-21903	OH

General Provider Information

NPI Number	:	1073809836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL E KACSMAR RPH

Provider Business Mailing Address
First Line	:	63 HIGHWAY 7 S
Second Line	:
City	:	POWHATAN POINT
State	:	OH
Zip	:	43942-1143
Country	:	US
Telephone Number	:	740-795-4837
Fax Number	:

Provider Business Practice Location Address
First Line	:	63 HIGHWAY 7 S
Second Line	:
City	:	POWHATAN POINT
State	:	OH
Zip	:	43942-1143
Country	:	US
Telephone Number	:	740-795-4837
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2011
Last Update Date	:	06/21/2011

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