# KLASS APOTHECARY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** TUCKERS PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417926262
- **Authorized official:** ROY KLASS BS RPH (OWNER)
- **Authorized official phone:** (937) 477-9653

## Contact information

- **Practice address:** 105 DR THATYE DRIVE, GLANDORF, OH 45848
- **Practice address phone:** (419) 538-7120
- **Practice address fax:** (419) 538-7121
- **Mailing address:** PO BOX 33, GLANDORF, OH 45848-0033
- **Mailing address phone:** (419) 538-7120
- **Mailing address fax:** (419) 538-7121

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 021756150 | OH | Yes |

## Other

- **Enumeration date:** 03/15/2006
- **Last updated:** 02/11/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2781306 | — | OH |
| 01 | — | 3669314 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |