MEDICARE: ZACKARY RYAN GAHM

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	183500000X	Pharmacist	03442145	OH

General Provider Information

NPI Number	:	1649992413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACKARY RYAN GAHM

Provider Business Mailing Address
First Line	:	68 HIGHLAND DR
Second Line	:
City	:	LUCASVILLE
State	:	OH
Zip	:	45648-8002
Country	:	US
Telephone Number	:	740-727-3578
Fax Number	:

Provider Business Practice Location Address
First Line	:	50A CENTER ST
Second Line	:
City	:	LUCASVILLE
State	:	OH
Zip	:	45648-7826
Country	:	US
Telephone Number	:	740-259-2442
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2022
Last Update Date	:	09/16/2022

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Directions to “ ZACKARY RYAN GAHM ” Practice Location

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