Healthcare Provider Details

I. General information

NPI: 1730214826
Provider Name (Legal Business Name): DEANS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 LOCUST ST
BROOKSVILLE KY
41004
US

IV. Provider business mailing address

PO BOX 6
BROOKSVILLE KY
41004
US

V. Phone/Fax

Practice location:
  • Phone: 606-735-2322
  • Fax: 606-735-2754
Mailing address:
  • Phone: 606-735-2322
  • Fax: 606-735-2754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPO1057
License Number StateKY

VIII. Authorized Official

Name: MRS. JACKIE H DEAN
Title or Position: TREASURER
Credential:
Phone: 606-735-2322