Provider Demographics
NPI:1215068531
Name:MAO PHARMACY INC
Entity type:Organization
Organization Name:MAO PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO AND PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:OLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:804-288-1933
Mailing Address - Street 1:8905 THREE CHOPT RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4663
Mailing Address - Country:US
Mailing Address - Phone:804-288-3620
Mailing Address - Fax:804-288-1508
Practice Address - Street 1:5823 PATTERSON AVE
Practice Address - Street 2:STE A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2536
Practice Address - Country:US
Practice Address - Phone:804-288-3620
Practice Address - Fax:804-288-1508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336M0002X
VA02010039853336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1215068531Medicaid
2105501OtherPK