1235213067 NPI number — BLUEGRASS FAMILY PHARMACY INC

Table of content: (NPI 1235213067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235213067 NPI number — BLUEGRASS FAMILY PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLUEGRASS FAMILY PHARMACY 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:
BLUEGRASS FAMILY PHARMACY
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:
1235213067
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2187 LEXINGTON RD
Provider Second Line Business Mailing Address:
STE 1
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40475-7919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-624-9797
Provider Business Mailing Address Fax Number:
859-624-9099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2187 LEXINGTON RD
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40475-7919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-624-9797
Provider Business Practice Location Address Fax Number:
859-624-9099
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BILITER
Authorized Official First Name:
DANNY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER,PIC,AO
Authorized Official Telephone Number:
859-624-9797

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: P07148 , 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: 54012307 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2034630 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com