Healthcare Provider Details

I. General information

NPI: 1639316243
Provider Name (Legal Business Name): MYS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2449 ROSS MILLVILLE RD STE 185
HAMILTON OH
45013-8951
US

IV. Provider business mailing address

2449 ROSS MILLVILLE RD STE 185
HAMILTON OH
45013-8951
US

V. Phone/Fax

Practice location:
  • Phone: 513-863-8000
  • Fax: 513-863-8001
Mailing address:
  • Phone: 513-863-8000
  • Fax: 513-863-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberOH2024
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number64001787A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number021877750
License Number StateOH

VIII. Authorized Official

Name: KARA ROLFES
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 513-863-8000