Provider Demographics
NPI:1912044538
Name:GAHM'S PHARMACY, INC
Entity Type:Organization
Organization Name:GAHM'S PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-876-9166
Mailing Address - Street 1:50-A CENTER STREET
Mailing Address - Street 2:
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45648-0001
Mailing Address - Country:US
Mailing Address - Phone:740-259-2442
Mailing Address - Fax:740-259-9341
Practice Address - Street 1:50-A CENTER STREET
Practice Address - Street 2:
Practice Address - City:LUCASVILLE
Practice Address - State:OH
Practice Address - Zip Code:45648-0001
Practice Address - Country:US
Practice Address - Phone:740-259-2442
Practice Address - Fax:740-259-9341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-09418503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0252177Medicaid
1274660001Medicare NSC