Provider Demographics
NPI:1992130173
Name:MLH-RX, LLC
Entity type:Organization
Organization Name:MLH-RX, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-392-4588
Mailing Address - Street 1:101 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:ELDON
Mailing Address - State:MO
Mailing Address - Zip Code:65026-1811
Mailing Address - Country:US
Mailing Address - Phone:573-392-4588
Mailing Address - Fax:573-392-4425
Practice Address - Street 1:101 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:ELDON
Practice Address - State:MO
Practice Address - Zip Code:65026-1811
Practice Address - Country:US
Practice Address - Phone:573-392-4588
Practice Address - Fax:573-392-4425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054.018532332B00000X
KS22-16480333600000X
AROS025093336C0003X
MO20130425413336C0004X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201197380AMedicaid
2143354OtherPK
MO601917602Medicaid
AR202851407Medicaid
AK1676643Medicaid
IA0121239Medicaid
AR202851407Medicaid