MEDICARE: NICHOLASVILLE PHARMACY SERVICES INC

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	3336C0004X	Compounding Pharmacy
3	3336L0003X	Long Term Care Pharmacy
4	3336C0003X	Community/Retail Pharmacy	P01818	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2126987	OTHER		PK

General Provider Information

NPI Number	:	1649382599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICHOLASVILLE PHARMACY SERVICES INC

Provider Business Mailing Address
First Line	:	465 KEENE CENTRE DR
Second Line	:
City	:	NICHOLASVILLE
State	:	KY
Zip	:	40356-1492
Country	:	US
Telephone Number	:	859-887-2841
Fax Number	:	859-887-1340

Provider Business Practice Location Address
First Line	:	465 KEENE CENTRE DR
Second Line	:
City	:	NICHOLASVILLE
State	:	KY
Zip	:	40356-1492
Country	:	US
Telephone Number	:	859-887-2841
Fax Number	:	859-887-1340

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MICHAEL DOWNS
Credential	:
Telephone Number	:	859-887-2841

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	09/19/2025

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