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Organization
KMG PHARMACY LLC
Active
Organization
KMG PHARMACY LLC
Active
Other names
KMG Pharmacy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MAHMOUD SHALTAF DR (OWNER, AO, PHCY MANAGER.)
(937) 829-1012
Entity
Organization
Contact information
Practice address
846 E MAIN ST, TROTWOOD, OH 45426-2911
(937) 529-4433
(937) 715-4447
Mailing address
846 E MAIN ST, TROTWOOD, OH 45426-2911
(937) 529-4433
(937) 715-4447
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
022532100
OH
3336C0004X
Compounding Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0146319
—
OH
01
—
2152395
PK
—
Enumeration date
09/17/2015
Last updated
08/17/2024
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