Healthcare Provider Details

I. General information

NPI: 1497754923
Provider Name (Legal Business Name): CENTRAL KENTUCKY APOTHECARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E CUMBERLAND ST
ALBANY KY
42602-1206
US

IV. Provider business mailing address

100 E CUMBERLAND ST
ALBANY KY
42602-1206
US

V. Phone/Fax

Practice location:
  • Phone: 606-387-6444
  • Fax: 606-387-9224
Mailing address:
  • Phone: 606-387-6444
  • Fax: 606-387-9224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberP07288
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberP07288
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ARICA V. COLLINS
Title or Position: PRESIDENT/CEO/OWNER
Credential: PHARM D.
Phone: 606-387-6444