MEDICARE: KAUP PHARMACY 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0004X	Compounding Pharmacy
4	3336H0001X	Home Infusion Therapy Pharmacy
5	3336S0011X	Specialty Pharmacy	020170400	OH
6	3336C0003X	Community/Retail Pharmacy	020170400	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2075707	OTHER	PK

General Provider Information

NPI Number	:	1568465060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAUP PHARMACY INC

Provider Business Mailing Address
First Line	:	PO BOX 605
Second Line	:
City	:	FORT RECOVERY
State	:	OH
Zip	:	45846-0605
Country	:	US
Telephone Number	:	419-375-2323
Fax Number	:	419-375-4488

Provider Business Practice Location Address
First Line	:	102 NORTH WAYNE STREET
Second Line	:
City	:	FT RECOVERY
State	:	OH
Zip	:	45846-0605
Country	:	US
Telephone Number	:	419-375-2323
Fax Number	:	419-375-4488

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JASON C ANDREWS
Credential	:
Telephone Number	:	419-375-2323

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	09/04/2024

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Directions to “KAUP PHARMACY INC ” Practice Location

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