1386646974 NPI number — INSTITUTIONAL PHARMACY INC

Table of content: (NPI 1386646974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386646974 NPI number — INSTITUTIONAL PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTITUTIONAL 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:
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:
1386646974
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1450
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORBIN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40702-1450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-528-9600
Provider Business Mailing Address Fax Number:
606-528-3873

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 E 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORBIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40701-1422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-528-9600
Provider Business Practice Location Address Fax Number:
606-528-3853
Provider Enumeration Date:
08/12/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FORCHT
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
606-528-9600

Provider Taxonomy Codes

  • Taxonomy code: 332BP3500X , with the licence number:  P06791 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 333600000X , with the licence number: P06791 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 001639570 . This is a "BCBS HIGHMARK" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 90008483 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000334951 . This is a "ANTHEM BCBS KY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0007732614 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".