1497754923 NPI number — CENTRAL KENTUCKY APOTHECARY

Table of content: (NPI 1497754923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497754923 NPI number — CENTRAL KENTUCKY APOTHECARY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL KENTUCKY APOTHECARY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DYER DRUG
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497754923
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E CUMBERLAND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42602-1206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-387-6444
Provider Business Mailing Address Fax Number:
606-387-9224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E CUMBERLAND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42602-1206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-387-6444
Provider Business Practice Location Address Fax Number:
606-387-9224
Provider Enumeration Date:
07/18/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COLLINS
Authorized Official First Name:
ARICA
Authorized Official Middle Name:
V.
Authorized Official Title or Position:
PRESIDENT/CEO/OWNER
Authorized Official Telephone Number:
606-387-6444

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  P07288 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: P07288 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: FLU0343 . This is a "NGS-MEDICARE MASS IMMUNIZER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100052570 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90020272 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".