Healthcare Provider Details

I. General information

NPI: 1225166440
Provider Name (Legal Business Name): EDMONSON DRUG COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PARK PLACE, STE 8
BROWNSVILLE KY
42210-0058
US

IV. Provider business mailing address

100 PARK PLACE , STE 8 PO BOX 58
BROWNSVILLE KY
42210-0058
US

V. Phone/Fax

Practice location:
  • Phone: 270-597-2386
  • Fax: 844-682-8099
Mailing address:
  • Phone: 270-597-2386
  • Fax: 844-682-8099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberP07681
License Number StateKY

VIII. Authorized Official

Name: DR. TREVOR RAY
Title or Position: SECRETARY
Credential: PHARMD
Phone: 270-597-2386