# KMG PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** KMG Pharmacy LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366811630
- **Authorized official:** MAHMOUD SHALTAF DR (OWNER, AO, PHCY MANAGER.)
- **Authorized official phone:** (937) 829-1012

## Contact information

- **Practice address:** 846 E MAIN ST, TROTWOOD, OH 45426-2911
- **Practice address phone:** (937) 529-4433
- **Practice address fax:** (937) 715-4447
- **Mailing address:** 846 E MAIN ST, TROTWOOD, OH 45426-2911
- **Mailing address phone:** (937) 529-4433
- **Mailing address fax:** (937) 715-4447

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 022532100 | OH | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 09/17/2015
- **Last updated:** 08/17/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0146319 | — | OH |
| 01 | — | 2152395 | PK | — |