Provider Demographics
NPI:1720350713
Name:MAHALAKSHMI, LLC
Entity Type:Organization
Organization Name:MAHALAKSHMI, LLC
Other - Org Name:HOME TOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ASHISH
Authorized Official - Middle Name:P
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:937-320-1500
Mailing Address - Street 1:3899 INDIAN RIPPLE RD
Mailing Address - Street 2:SUITE-A
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3410
Mailing Address - Country:US
Mailing Address - Phone:937-672-3690
Mailing Address - Fax:937-320-1507
Practice Address - Street 1:3899 INDIAN RIPPLE RD
Practice Address - Street 2:SUITE-A
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440-3410
Practice Address - Country:US
Practice Address - Phone:937-320-1500
Practice Address - Fax:937-320-1507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0221771003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0060845Medicaid
OH6717720001Medicare NSC