MEDICARE: CCF PHARMACIST INTERVENTIONS & COMMUNITY CONSULTING SERVICES

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	P06874	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1833525	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1437497104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CCF PHARMACIST INTERVENTIONS & COMMUNITY CONSULTING SERVICES

Provider Business Mailing Address
First Line	:	1522 DIXIE HWY STE 123
Second Line	:	CCF PI CCS
City	:	PARK HILLS
State	:	KY
Zip	:	41011-2847
Country	:	US
Telephone Number	:	859-491-0900
Fax Number	:	859-491-4907

Provider Business Practice Location Address
First Line	:	1522 DIXIE HWY STE 123
Second Line	:	CCF PI CCS
City	:	PARK HILLS
State	:	KY
Zip	:	41011-2847
Country	:	US
Telephone Number	:	859-491-0900
Fax Number	:	859-491-4907

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	CELESTE FLICK
Credential	:
Telephone Number	:	859-491-0900

Provider Enumeration Date	:	01/30/2013
Last Update Date	:	01/30/2013

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