Provider Demographics
NPI:1326145269
Name:MIAMI VALLEY MEDICAL SUPPLIES INC.
Entity Type:Organization
Organization Name:MIAMI VALLEY MEDICAL SUPPLIES INC.
Other - Org Name:CENTERVILLE LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MOWBRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-435-5751
Mailing Address - Street 1:9352 DAYTON LEBANON PIKE STE B
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-3843
Mailing Address - Country:US
Mailing Address - Phone:937-435-5751
Mailing Address - Fax:937-435-5759
Practice Address - Street 1:9352 DAYTON LEBANON PIKE STE B
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-3843
Practice Address - Country:US
Practice Address - Phone:937-435-5751
Practice Address - Fax:937-435-5759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0210405003336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2056706Medicaid
3670761OtherOTHER ID NUMBER-COMMERCIAL NUMBER
OH2056706Medicaid