1649336348 NPI number — CARPENTER DENT DRUGS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649336348 NPI number — CARPENTER DENT DRUGS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARPENTER DENT DRUGS INC
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:
PHARMACY DME
Provider Other Organization Name Type Code:
5
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:
1649336348
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1088 VETERANS MEMORIAL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-237-4446
Provider Business Mailing Address Fax Number:
270-237-7782

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1088 VETERANS MEMORIAL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-237-4446
Provider Business Practice Location Address Fax Number:
270-237-7782
Provider Enumeration Date:
12/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MEADOR
Authorized Official First Name:
MARK
Authorized Official Middle Name:
WILSON
Authorized Official Title or Position:
PRESIDENT PHARMACIST OWNER
Authorized Official Telephone Number:
270-237-4446

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  90030024 , 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: P06611 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 90030024 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".