MEDICARE: KARL ROAD DRUGGIST 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	RTP02244525003	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	H316790	OTHER	PART B VACCINE PTAN
2	2149127	OTHER	PK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417935297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KARL ROAD DRUGGIST LLC

Provider Business Mailing Address
First Line	:	PO BOX 126
Second Line	:
City	:	PLAIN CITY
State	:	OH
Zip	:	43064-0126
Country	:	US
Telephone Number	:	614-573-1557
Fax Number	:	614-300-7558

Provider Business Practice Location Address
First Line	:	5770 KARL RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-3604
Country	:	US
Telephone Number	:	614-847-3784
Fax Number	:	614-847-6171

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	LONNIE CRAFT
Credential	:	RPH
Telephone Number	:	614-573-1557

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	03/12/2020

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