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
—
—
333600000X
Pharmacy
—
—
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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