Healthcare Provider Details

I. General information

NPI: 1417496621
Provider Name (Legal Business Name): PROHEALTH DRUGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5045 CROOKSHANK RD STE 100
CINCINNATI OH
45238-3301
US

IV. Provider business mailing address

PO BOX 786
DAYTON OH
45401-0786
US

V. Phone/Fax

Practice location:
  • Phone: 513-429-5424
  • Fax: 513-429-3526
Mailing address:
  • Phone: 513-429-5424
  • Fax: 513-429-3526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number02266485003
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MAHMOUD RIFAI
Title or Position: OWNER, PHARMACIST
Credential:
Phone: 937-389-0000