MEDICARE: GAHM'S PHARMACY II, INC.

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	3336L0003X	Long Term Care Pharmacy
2	3336C0003X	Community/Retail Pharmacy	02-1228850	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3668653	OTHER	OH	NCPDP NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710999586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GAHM'S PHARMACY II, INC.

Provider Business Mailing Address
First Line	:	1565 GALENA PIKE
Second Line	:
City	:	WEST PORTSMOUTH
State	:	OH
Zip	:	45663-6059
Country	:	US
Telephone Number	:	740-858-5000
Fax Number	:	740-858-9177

Provider Business Practice Location Address
First Line	:	1565 GALENA PIKE
Second Line	:
City	:	WEST PORTSMOUTH
State	:	OH
Zip	:	45663-6059
Country	:	US
Telephone Number	:	740-858-5000
Fax Number	:	740-858-9177

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KEVIN M GAHM
Credential	:	RPH
Telephone Number	:	740-858-5000

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	02/25/2020

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