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Organization
DAYTON MALL FOODS LLC
Active
Organization
DAYTON MALL FOODS LLC
Active
Other names
CUB PHARMACY 609
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE LOFINO (PRESIDENT)
(937) 431-1662
Entity
Organization
Contact information
Practice address
8245 SPRINGBORO PIKE, MIAMISBURG, OH 45342-6103
(937) 434-5778
(937) 434-0545
Mailing address
8245 SPRINGBORO PIKE, MIAMISBURG, OH 45342-6103
(937) 439-0452
(937) 434-0545
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
RTP020941000
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0271147
—
OH
01
—
3662459
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/27/2006
Last updated
04/25/2012
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