MEDICARE: ROBERT D MABE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	02-0636300	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225029457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT D MABE INC.

Provider Business Mailing Address
First Line	:	PO BOX 165
Second Line	:
City	:	ASHVILLE
State	:	OH
Zip	:	43103-0165
Country	:	US
Telephone Number	:	740-983-2501
Fax Number	:	740-983-2503

Provider Business Practice Location Address
First Line	:	3400 STATE ROUTE 752
Second Line	:
City	:	ASHVILLE
State	:	OH
Zip	:	43103-9685
Country	:	US
Telephone Number	:	740-983-2501
Fax Number	:	740-983-2503

Authorized Official
Title or Position	:	OWNER/PHARMACIST
Name	:	MR. ROBERT D MABE
Credential	:	R.PH.
Telephone Number	:	740-983-2501

Provider Enumeration Date	:	11/05/2005
Last Update Date	:	01/29/2019

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