MEDICARE: PRESCRIPTION SHOPPE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	60003268A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134163256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESCRIPTION SHOPPE LLC

Provider Business Mailing Address
First Line	:	PO BOX 714
Second Line	:
City	:	WASHINGTON
State	:	IN
Zip	:	47501-0714
Country	:	US
Telephone Number	:	812-254-7666
Fax Number	:

Provider Business Practice Location Address
First Line	:	2005 STATE ST
Second Line	:	STE B
City	:	WASHINGTON
State	:	IN
Zip	:	47501-8505
Country	:	US
Telephone Number	:	812-254-7666
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KENNETH RAY HOLLAND
Credential	:
Telephone Number	:	812-254-7666

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	05/11/2009

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Directions to “PRESCRIPTION SHOPPE LLC ” Practice Location

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