Healthcare Provider Details

I. General information

NPI: 1003810490
Provider Name (Legal Business Name): KNOX PROFESSIONAL PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 KNOX ST
BARBOURVILLE KY
40906-1330
US

IV. Provider business mailing address

511 KNOX ST
BARBOURVILLE KY
40906-1330
US

V. Phone/Fax

Practice location:
  • Phone: 606-546-3171
  • Fax: 606-546-5022
Mailing address:
  • Phone: 606-546-3171
  • Fax: 606-546-5022

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 TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP01088
License Number StateKY

VIII. Authorized Official

Name: GEORGE HAMMONS
Title or Position: OWNER
Credential: RPH
Phone: 606-546-3171