Provider Demographics
NPI:1780373423
Name:KRSAK, KARA A
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:A
Last Name:KRSAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 NORTH PLAINS ROAD
Mailing Address - Street 2:
Mailing Address - City:THE PLAINS
Mailing Address - State:OH
Mailing Address - Zip Code:45780
Mailing Address - Country:US
Mailing Address - Phone:740-797-2546
Mailing Address - Fax:
Practice Address - Street 1:93 NORTH PLAINS ROAD
Practice Address - Street 2:
Practice Address - City:THE PLAINS
Practice Address - State:OH
Practice Address - Zip Code:45780
Practice Address - Country:US
Practice Address - Phone:740-797-2546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09118280183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician