1942398995 NPI number — COVERMYMEDS PHARMACY LLC

Table of content: (NPI 1942398995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942398995 NPI number — COVERMYMEDS PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COVERMYMEDS PHARMACY LLC
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:
1942398995
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5101 JEFF COMMERCE DRIVE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40219-3336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-810-1184
Provider Business Mailing Address Fax Number:
502-753-8393

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5101 JEFF COMMERCE DR STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40219-3336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-810-1184
Provider Business Practice Location Address Fax Number:
502-753-8393
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STURGILL
Authorized Official First Name:
DERRICK
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
PRESIDENT; MANAGER
Authorized Official Telephone Number:
513-465-4992

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336M0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; 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: "Y" .

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

  • Identifier: 05298 . This is a "PHARMACY STATE LICENSE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 148351 . This is a "PHARMACY STATE LICENSE" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: PH01678 . This is a "PHARMACY STATE LICENSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 7100332610 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1827104 . This is a "NCPDP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: OSP.0005286 . This is a "PHARMACY STATE LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: PH21507 . This is a "PHARMACY STATE LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: PHNR000170 . This is a "PHARMACY STATE LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 021545800 . This is a "PHARMACY STATE LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 324 . This is a "PHARMACY STATE LICENSE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: NP000514 . This is a "PHARMACY STATE LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 036359 . This is a "PHARMACY STATE LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 112709 . This is a "PHARMACY STATE LICENSE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 400-2023 . This is a "PHARMACY STATE LICENSE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 5110 . This is a "PHARMACY STATE LICENSE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 5301008241 . This is a "PHARMACY STATE LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: OS01489 . This is a "PHARMACY STATE LICENSE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: PCN.0000417 . This is a "PHARMACY STATE LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: PMP-1640 . This is a "PHARMACY STATE LICENSE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 28RO00034400 . This is a "PHARMACY STATE LICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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