Provider Demographics
NPI:1124856703
Name:KMG PHARMACY LLC
Entity type:Organization
Organization Name:KMG PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:JAMIL
Authorized Official - Last Name:SHALTAF
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:708-589-5668
Mailing Address - Street 1:846 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-2911
Mailing Address - Country:US
Mailing Address - Phone:937-529-4433
Mailing Address - Fax:937-715-4447
Practice Address - Street 1:846 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-2911
Practice Address - Country:US
Practice Address - Phone:937-529-4433
Practice Address - Fax:937-715-4447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy