Healthcare Provider Details

I. General information

NPI: 1922391739
Provider Name (Legal Business Name): BLUEGRASS DRUG CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 HIGHWAY 42 E
BEDFORD KY
40006-7624
US

IV. Provider business mailing address

835 W MAIN ST
MADISON IN
47250-3131
US

V. Phone/Fax

Practice location:
  • Phone: 502-255-3540
  • Fax: 502-255-3615
Mailing address:
  • Phone: 812-265-4621
  • Fax: 812-273-6666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07452
License Number StateKY

VIII. Authorized Official

Name: ERIK GROVE
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 502-255-3540