Provider Demographics
NPI:1699127357
Name:KAISER COMMUNITY PHARMACY LLC
Entity type:Organization
Organization Name:KAISER COMMUNITY PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-668-8101
Mailing Address - Street 1:251 BENEDICT AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2346
Mailing Address - Country:US
Mailing Address - Phone:419-668-1078
Mailing Address - Fax:419-663-5837
Practice Address - Street 1:251 BENEDICT AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2346
Practice Address - Country:US
Practice Address - Phone:419-668-1078
Practice Address - Fax:419-663-5837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
OHPMY.022651150-03333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2162323OtherPK