Basic Information
| Provider Information | |||||||||
| NPI: | 1942755285 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KAISER COMMUNITY PHARMACY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 272 BENEDICT AVE | ||||||||
| Address2: | |||||||||
| City: | NORWALK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448572374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196688101 | ||||||||
| FaxNumber: | 4196636036 | ||||||||
| Practice Location | |||||||||
| Address1: | 251 BENEDICT AVE | ||||||||
| Address2: | |||||||||
| City: | NORWALK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448572346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196681078 | ||||||||
| FaxNumber: | 4196635837 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2016 | ||||||||
| LastUpdateDate: | 12/21/2016 | ||||||||
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| AuthorizedOfficialLastName: | FRIES | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 4196602535 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FISHER-TITUS MEDICAL CENTER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.