1720081763 NPI number — TOWNE & COUNTRY PHARMACY FLORIST & GIFTS INC

Table of content: (NPI 1720081763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720081763 NPI number — TOWNE & COUNTRY PHARMACY FLORIST & GIFTS INC

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
TOWNE & COUNTRY PHARMACY FLORIST & GIFTS 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:
1720081763
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 364
Provider Second Line Business Mailing Address:
675 EAST HWY 60
Provider Business Mailing Address City Name:
HARDINSBURG
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40143-0364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-756-2151
Provider Business Mailing Address Fax Number:
270-756-5199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
675 EAST HWY 60
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARDINSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40143-0675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-756-2151
Provider Business Practice Location Address Fax Number:
270-756-5199
Provider Enumeration Date:
05/23/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILLOUGHBY
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
GAYLE
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
270-756-2151

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  P06296 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: MG0340 , 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: P06296 , 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: 54032560 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90050147 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000189330 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1071411 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".