MEDICARE: STEPHEN MAH RPH

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	15059	CO

General Provider Information

NPI Number	:	1639513021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN MAH RPH

Provider Business Mailing Address
First Line	:	4600 LEETSDALE DR
Second Line	:	KING SOOPERS PHARMACY DEPT.
City	:	GLENDALE
State	:	CO
Zip	:	80246-1311
Country	:	US
Telephone Number	:	303-320-3110
Fax Number	:	303-320-3112

Provider Business Practice Location Address
First Line	:	4600 LEETSDALE DR
Second Line	:	KING SOOPERS PHARMACY DEPT.
City	:	GLENDALE
State	:	CO
Zip	:	80246-1311
Country	:	US
Telephone Number	:	303-320-3110
Fax Number	:	303-320-3112

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

Provider Enumeration Date	:	04/29/2013
Last Update Date	:	04/29/2013

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