Provider Demographics
NPI:1629097779
Name:OH MUHLENBERG, LLC
Entity Type:Organization
Organization Name:OH MUHLENBERG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SYSTEM CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:ORANGE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:270-338-8276
Mailing Address - Street 1:440 HOPKINSVILLE ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345-1124
Mailing Address - Country:US
Mailing Address - Phone:270-338-8406
Mailing Address - Fax:270-338-8407
Practice Address - Street 1:440 HOPKINSVILLE ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42345-1124
Practice Address - Country:US
Practice Address - Phone:270-338-8406
Practice Address - Fax:270-338-8407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
KYP076963336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2029268OtherPK
KY7100439910Medicaid
KY7100415930Medicaid