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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
022532100
OH
3336C0004X
Compounding Pharmacy
—
—
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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