Healthcare Provider Details

I. General information

NPI: 1225029457
Provider Name (Legal Business Name): ROBERT D MABE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2005
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 STATE ROUTE 752
ASHVILLE OH
43103-9685
US

IV. Provider business mailing address

PO BOX 165
ASHVILLE OH
43103-0165
US

V. Phone/Fax

Practice location:
  • Phone: 740-983-2501
  • Fax: 740-983-2503
Mailing address:
  • Phone: 740-983-2501
  • Fax: 740-983-2503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number02-0636300
License Number StateOH

VIII. Authorized Official

Name: MR. ROBERT D MABE
Title or Position: OWNER/PHARMACIST
Credential: R.PH.
Phone: 740-983-2501