1114539822 NPI number — B&B PHARMACY, PLLC

Table of content: (NPI 1114539822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114539822 NPI number — B&B PHARMACY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
B&B PHARMACY, PLLC
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:
6
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:
1114539822
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
126 SHADOWMEADE LANE
Provider Second Line Business Mailing Address:
UNIT 2
Provider Business Mailing Address City Name:
MOUNT WASHINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-538-5000
Provider Business Mailing Address Fax Number:
502-538-0330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
126 SHADOWMEADE LANE
Provider Second Line Business Practice Location Address:
UNIT 2
Provider Business Practice Location Address City Name:
MOUNT WASHINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-538-5000
Provider Business Practice Location Address Fax Number:
502-538-0330
Provider Enumeration Date:
08/24/2020

Additional Information

Authorized Official

Authorized Official Last Name:
BARGER
Authorized Official First Name:
ELLEN
Authorized Official Middle Name:
KRAJEWSKI
Authorized Official Title or Position:
PIC
Authorized Official Telephone Number:
502-543-8200

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7100696040 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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