1548336647 NPI number — B & K PHARMACY INC

Table of content: (NPI 1548336647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548336647 NPI number — B & K PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
B & K 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:
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:
1548336647
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
412 CENTRAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
S WILLIAMSON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41503-4121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-237-7430
Provider Business Mailing Address Fax Number:
606-237-7438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
412 CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
S WILLIAMSON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41503-4121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-237-7430
Provider Business Practice Location Address Fax Number:
606-237-7438
Provider Enumeration Date:
11/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BARNETT
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRES AND PHARM
Authorized Official Telephone Number:
606-237-7430

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: P02080 , 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: 7100185980 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0139281000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2031362 . This is a "PK" identifier . This identifiers is of the category "OTHER".