MEDICARE: JOHN CHARLES KAMENIK PHARMD

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	03328889	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1952335663	OTHER		NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811414725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN CHARLES KAMENIK PHARMD

Provider Business Mailing Address
First Line	:	1060 ASHLAND RD
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44905-2157
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1060 ASHLAND RD
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44905-2157
Country	:	US
Telephone Number	:	419-589-3693
Fax Number	:

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

Provider Enumeration Date	:	08/23/2017
Last Update Date	:	03/07/2023

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