Healthcare Provider Details

I. General information

NPI: 1831134030
Provider Name (Legal Business Name): ST JOSEPH BEREA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 ESTILL ST
BEREA KY
40403-1742
US

IV. Provider business mailing address

305 ESTILL ST
BEREA KY
40403-1742
US

V. Phone/Fax

Practice location:
  • Phone: 859-986-6541
  • Fax: 859-986-2697
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPO6847
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAMIE JONES
Title or Position: PIC
Credential: RPH
Phone: 859-986-6541