=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578376026
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAH PHARMACY, L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2025
-----------------------------------------------------
Last Update Date | 07/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4867 DIXIE HWY
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45014-1933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-716-0107
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4867 DIXIE HWY
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45014-1933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT PHARMACY PRACTICE
-----------------------------------------------------
Name | SUSAN PEPPERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 513-678-3901
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------