Healthcare Provider Details

I. General information

NPI: 1326145269
Provider Name (Legal Business Name): MIAMI VALLEY MEDICAL SUPPLIES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9352 DAYTON LEBANON PIKE STE B
CENTERVILLE OH
45458-3843
US

IV. Provider business mailing address

9352 DAYTON LEBANON PIKE STE B
CENTERVILLE OH
45458-3843
US

V. Phone/Fax

Practice location:
  • Phone: 937-435-5751
  • Fax: 937-435-5759
Mailing address:
  • Phone: 937-435-5751
  • Fax: 937-435-5759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number021040500
License Number StateOH

VIII. Authorized Official

Name: THOMAS MOWBRAY
Title or Position: PRESIDENT
Credential:
Phone: 937-435-5751