1114658861 NPI number — OPTION PHARMACY LLC

Table of content: (NPI 1114658861)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114658861 NPI number — OPTION PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTION PHARMACY LLC
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:
Provider Other Organization Name Type Code:
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:
1114658861
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3200 GREENWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOPKINSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42240-3810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-797-7301
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
238 SOUTH EWING STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GUTHRIE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-797-7301
Provider Business Practice Location Address Fax Number:
270-640-0071
Provider Enumeration Date:
06/23/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ASHBY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
PHARMACIST/PRESIDENT
Authorized Official Telephone Number:
859-797-7301

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X ; 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)