Provider Demographics
NPI:1225029457
Name:ROBERT D MABE INC.
Entity Type:Organization
Organization Name:ROBERT D MABE INC.
Other - Org Name:ASHVILLE APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:MABE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:740-983-2501
Mailing Address - Street 1:PO BOX 165
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43103-0165
Mailing Address - Country:US
Mailing Address - Phone:740-983-2501
Mailing Address - Fax:740-983-2503
Practice Address - Street 1:3400 STATE ROUTE 752
Practice Address - Street 2:
Practice Address - City:ASHVILLE
Practice Address - State:OH
Practice Address - Zip Code:43103-9685
Practice Address - Country:US
Practice Address - Phone:740-983-2501
Practice Address - Fax:740-983-2503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-05
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-0636300333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0396174Medicaid
OH0396174Medicaid