Provider Demographics
NPI:1417496621
Name:PROHEALTH DRUGS LLC
Entity Type:Organization
Organization Name:PROHEALTH DRUGS LLC
Other - Org Name:MED MART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:RIFAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-389-0000
Mailing Address - Street 1:PO BOX 786
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45401-0786
Mailing Address - Country:US
Mailing Address - Phone:513-429-5424
Mailing Address - Fax:513-429-3526
Practice Address - Street 1:5045 CROOKSHANK RD STE 100
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-3301
Practice Address - Country:US
Practice Address - Phone:513-429-5424
Practice Address - Fax:513-429-3526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02266485003333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167806OtherPK