Healthcare Provider Details

I. General information

NPI: 1528141603
Provider Name (Legal Business Name): THREE STORES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 KY HIGHWAY 3444 SUITE 2
ANNVILLE KY
40402-0095
US

IV. Provider business mailing address

PO BOX 1569
HAZARD KY
41702-1569
US

V. Phone/Fax

Practice location:
  • Phone: 606-364-3113
  • Fax:
Mailing address:
  • Phone: 606-436-2407
  • Fax: 606-436-0727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07199
License Number StateKY

VIII. Authorized Official

Name: HEATHER DANIELS
Title or Position: EXEXUTIVE ADMINISTRATOR
Credential:
Phone: 606-436-2407