NPIMap

Organization Active NPI

KMG Pharmacy LLC

  • Community/Retail Pharmacy
  • Trotwood, OH
National Provider Identifier
1366811630
Registry record updated Aug 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
022532100 Issued in OH
Legal business name
KMG PHARMACY LLC
Doing business as
KMG Pharmacy LLC
Practice address
846 E Main St
Trotwood, OH 45426-2911
Phone
(937) 529-4433
Fax
(937) 715-4447
NPI assigned
Sep 17, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mahmoud Shaltaf, DRNPI 1578861944
Title
Owner, Ao, Phcy Manager.
Phone
(937) 829-1012

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 022532100 OH Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

846 E Main St
Trotwood, OH 45426-2911

Mailing address

846 E Main St
Trotwood, OH 45426-2911
Phone (937) 529-4433

Other identifiers 2

IdentifierTypeStateIssuer
0146319MedicaidOH
2152395OtherPK

Other names 1

  • KMG Pharmacy LLC Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1442448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723852800000",
    "number": "1366811630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "846 E MAIN ST",
            "city": "TROTWOOD",
            "state": "OH",
            "postal_code": "454262911",
            "telephone_number": "937-529-4433",
            "fax_number": "937-715-4447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "846 E MAIN ST",
            "city": "TROTWOOD",
            "state": "OH",
            "postal_code": "454262911",
            "telephone_number": "937-529-4433",
            "fax_number": "937-715-4447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KMG PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-17",
        "last_updated": "2024-08-17",
        "certification_date": "2024-08-17",
        "status": "A",
        "authorized_official_last_name": "SHALTAF",
        "authorized_official_first_name": "MAHMOUD",
        "authorized_official_title_or_position": "OWNER,  AO, PHCY MANAGER.",
        "authorized_official_telephone_number": "937-829-1012",
        "authorized_official_credential": "DR"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OH",
            "license": "022532100",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0146319",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2152395",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KMG Pharmacy LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Trotwood, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.