Healthcare Provider Details

I. General information

NPI: 1679785588
Provider Name (Legal Business Name): KEVIN MICHAEL GAHM RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 GALENA PIKE
WEST PORTSMOUTH OH
45663-6059
US

IV. Provider business mailing address

1068 MORRIS LANE BLUE RUN RD # A
LUCASVILLE OH
45648-8702
US

V. Phone/Fax

Practice location:
  • Phone: 740-858-5000
  • Fax: 740-858-9177
Mailing address:
  • Phone: 740-259-0306
  • Fax: 740-858-9177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-2-21280
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: