MEDICARE: RXSHOP

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	P07732	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1803104	OTHER		NCPDP NUMBER

General Provider Information

NPI Number	:	1780671941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RXSHOP

Provider Business Mailing Address
First Line	:	1571 KY HIGHWAY 259 N
Second Line	:	PO BOX 540
City	:	BROWNSVILLE
State	:	KY
Zip	:	42210-9206
Country	:	US
Telephone Number	:	270-597-2181
Fax Number	:	270-936-8602

Provider Business Practice Location Address
First Line	:	1571 KY HIGHWAY 259 N
Second Line	:
City	:	BROWNSVILLE
State	:	KY
Zip	:	42210-9206
Country	:	US
Telephone Number	:	270-597-2181
Fax Number	:	270-936-8602

Authorized Official
Title or Position	:	PHARMACY OPERATIONS MANAGER
Name	:	MR. RANDALL T YOUNG
Credential	:	RPH
Telephone Number	:	270-597-2181

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	08/26/2016

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Practice Location Address:

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1639283963 — TORI L ROBINSON APRN
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1306954706 — MR. RANDALL THEODORE YOUNG RPH
Practice Location Address:

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1063871812 — RXSHOP, LLC
Practice Location Address:

1571 KY HIGHWAY 259 N
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42210-9206

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1588662969 — TRI-COUNTY HEALTH CARE, INC.
Practice Location Address:

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1992777866 — DR. SANJAY KAUL MD
Practice Location Address:

104 MOHAWK ST , 104 MOHAWK STREET
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Directions to “RXSHOP ” Practice Location

Language	Start Address	Practice Location

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