MEDICARE: MR. KEVIN MICHAEL GAHM RPH

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	03-2-21280	OH

General Provider Information

NPI Number	:	1679785588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN MICHAEL GAHM RPH

Provider Business Mailing Address
First Line	:	1068 MORRIS LANE BLUE RUN RD # A
Second Line	:
City	:	LUCASVILLE
State	:	OH
Zip	:	45648-8702
Country	:	US
Telephone Number	:	740-259-0306
Fax Number	:	740-858-9177

Provider Business Practice Location Address
First Line	:	1565 GALENA PIKE
Second Line	:
City	:	WEST PORTSMOUTH
State	:	OH
Zip	:	45663-6059
Country	:	US
Telephone Number	:	740-858-5000
Fax Number	:	740-858-9177

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

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/08/2007

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