Healthcare Provider Details

I. General information

NPI: 1578376026
Provider Name (Legal Business Name): MAH PHARMACY, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4867 DIXIE HWY
FAIRFIELD OH
45014-1933
US

IV. Provider business mailing address

4867 DIXIE HWY
FAIRFIELD OH
45014-1933
US

V. Phone/Fax

Practice location:
  • Phone: 866-716-0107
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SUSAN PEPPERS
Title or Position: VICE PRESIDENT PHARMACY PRACTICE
Credential:
Phone: 513-678-3901